Customer Service Manager

NATALIE PENA

Cellular: 321-***-**** **** SW *rd Ct.

E-mail: *******@*****.*** Pembroke Pines, FL 33025

Career Summary

A highly talented and driven professional with excellent experience in customer services, pharmacy operations, and Call center knowledge, good verbal and written communication skills. An individual with responsibility and dependability to work independently or within a team management environment. My primary strengths are general management skills, financial, and a good history of leading people and achieving goals. Areas of expertise:

• Problem Solving • Scheduling / Budget

• Analyze call center metrics • Pharmacy Benefits management

• Quality Assurance • Staffing, Training and Mentoring employees

• Bilingual- Spanish/English • Microsoft Office (Word, Excel, PowerPoint)

• Insurance verifications • Pharmacy Operations

• Managed Care • Billing and reimbursement

Professional Background

South Miami Pharmacy- Specialty Dept. – Miami, FL June 2014- June 2015

Specialty Operations Manager

- Manage the staff in the specialty dept. including work flow, training and communication standards

- Supervise the daily operations of the pharmacy

- Manage day-to-day provider relations activities, questions, and escalated issues

-Created and implemented workflow procedures for Pharmacy technician, CSR, and Care Coordinators.

-Conduct performance reviews, quarterly check-ins and staff 1:1s to guide performance management and employee development efforts and manage toward departmental goals.

- Conduct interviews and hiring

-Created, implemented, and trained the staff on policies and procedures

- Established job requirements and skill competency criteria used in hiring process

-Ensure all prescriptions are input, filled and dispensed accurately, timely and within budget

-Develop training procedure manual to include each functional area within the pharmacy

-Oversee purchasing for operations, including drugs and all supplies required, and manage inventory.

- ensure prior authorization/refills are handled effectively and in a timely manner.

-Prepare and generate inventory and utilization reports

- Personnel management including Staffing/ selection and training/ performance appraisals, mentoring, counseling and disciplinary actions.

- Develop and update workflows and documentation of processes and procedures

- Participate in new client implementation meetings, finalists meetings, and conferences

- Resolve day to day issues for clients and assist Account Executives, on all aspects of supporting client specific strategic plans.

- Monitor dispensing of drugs, supplies, and inventory levels

-Oversee the scheduling of pharmacy staff to assure adequate and consistent service

-screened applicants and resumes for qualifications best fit for the position; interviewed, and oriented new hires.

Commcare Specialty Pharmacy/ Premier Inc- Ft Lauderdale, FL April 2010- June 2014

Health-systems account manager/ Patient navigator lead

-Serve as the day-to-day contact for assigned accounts, interact with client contacts to facilitate problem resolution and promote high client satisfaction

-Responsible for collecting relevant discharge reports, labs, and referrals for assigned patients and integrated into electronic health records from physicians, hospitals, and case managers for new clients.

-Maintain contracts and correspondence files in organized and accessible manner for all providers

-Serve as primary contact for health systems, PBM clients, Managed Care accounts, and account executives

-Create compliance and status reports

-Perform and analyze compliance assessments

-Schedule and Attend pharmaceutical in- Services

- Conduct hiring, training, and evaluation of staff.

-Collaborate to create or improve work flow process

-Conduct Insurance verification and eligibility

-Assist patients with insurance questions regarding billing, reimbursement, including but not limited to Medicare and Medicaid(SOC)

-Contact identified patients to arrange follow up appointments to their primary care physician, specialists and other providers as ordered.

-Coordinate and schedule the patients medication shipments and administration appointments

-Assist patients with copay assistance through foundations, manufacturer assistant programs, and check eligibility for state waiver and other community and state programs.

-Resolve pharmacy Claim rejections by contacting the Insurances for all disease states

-Handle escalated prior authorizations and pre- certifications for all disease states.

-Contact patients to ensure compliance, discuss side effects, and treatment regimens for the following disease states IVIG, Oncology, hepatitis C, MS, RA, Derm and HIV.

Express-scripts Pharmacy - Orlando, Florida

June-2006 – April 2010

Pharmacy benefits Coordinator- Supervisor

-Handle escalated inquiries from members, physicians and internal/external clients related to pharmacy benefits

- Conduct hiring, training, and evaluation of staff. Provide on-going coaching to each patient care representative

-Assist clients in understanding and maximizing the use of their pharmacy distribution program

-Ensure customer care representatives are performing accurate insurance verifications

-Support clients inquiries related to pharmacy benefits, while maintaining productivity standards and performance guarantees where applicable

-Provide Physicians and Clients of selected plans with information regarding their patient’s benefits and assist with prior authorizations, Claims and overrides

-Perform eligibility and insurance verifications

-Assist in development of Call Center programs and process improvements to enhance the level of internal and external customer service provided.

-Work with other operational departments to research and resolve mail order, claims issues, and respond to members within performance agreement guidelines

-Research and resolve problems in a timely manner.

Cleartel Communications - Orlando, Florida

July 2003 – June 2006

Customer Service- Business Team

-Handles client requests inquiries on installation, billing or changes to current telephone services

-Minimizes transfers and increase the customer experience by taking ownership of the issue until resolution

-Provide detailed product information to solve customers’ telecommunication needs on every call

-Strives to retain customers by providing outstanding service on every call

-Investigates and resolves inquiries, disputes and complaints regarding customer service team members

-Utilizes multiple computer systems to initiate, track, resolve and document customer service needs

-Perform other customer service duties as assigned

-Responsible for creating and renewing Business customer’s contracts.

Customer Service Supervisor

-Monitor and analyze key call center metrics. Maintain weekly and monthly productivity reports.

-Provide employees with feedback for job development. Trained and mentored new employees

-Perform call monitoring to help determine necessary training needs as well as ensuring proper phone etiquette.

-Conducted monthly coaching sessions with each team member, providing feedback about performance, attendance, work habits, goals, areas of improvement and recognition.

-Conduct department meetings to keep staff informed of all service-related updates, new products, etc.

-Analyzed billing issues, Provisioned plan upgrades, and assisted with processing payment

-Process Timecards and Payroll through ADP

-Responsible for executing disciplinary actions within company guidelines and policy

Major Accounts -Manager

-Overall responsibility for the management of a small group of assigned accounts, focusing on retention (through securing long term contracts) and profitable growth of existing revenue streams as well as conducting strategic planning activities to ensure customers' product and service needs are anticipated.

-Conduct hiring, training, and evaluation of staff. Provide on-going coaching to each CSR

-Knowledgeable of client’s contract status and follow through to renewal, starting 90 days before contract expiration, with each client

-Conduct follow-up on all maintenance accounts to ensure client satisfaction

-Serves as the project manager, managing a comprehensive work plan to ensure an effective implementation of new clients services

-Receive and handled issues from clients who’s bill excess over $500.00 and result on first call resolution or follow up

-Periodically call customer base as a courtesy and retention tool. Provide professional and technical advice on business applications to ensure account satisfaction by fulfilling customer needs.

-Research, analyze, and process contracts and credit adjustments as required.

PARALEGAL MULTI-SERVICES Inc. - Orlando, Florida

Senior Administrative Assistant

March 2001– July 2003

-Perform office procedures in the everyday running of a legal office

-Train and supervise new administrative assistants and seasonal temporary employees when necessary

-Interview potential candidates

-Maintained and document

-Process employee timecards and weekly payroll

-Prepare invoices, letters, memos, financial statements and other documents

-Maintain complex and confidential dockets and files

-Coordinated meetings

-Prepare and interpret immigration documents

-Prepare documents and organized materials for civil and immigration files

-Scheduled client appointments and completed immigration form

-Developed spreadsheets

-Responsible for answering phones calls and greeting visitors

-Duties also included but not limited to filing, faxing, ordering supplies and data entry

Education

2004-2007 Valencia Community College -Associates Degree

2013-2015 University of Phoenix Bachelor’s Degree- Psychology

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