Cynthia Pruett

**** ***** **.

Plano, Texas

Cellular: 214-***-**** Email: acxnkl@r.postjobfree.com

Healthcare Analyst

Healthcare Professional (Pharmacist) offering over 20 years of experience in Medication,

Management, Clinical Consulting, Pharmacy Operations and Regulatory Compliance

OVERVIEW

International work experience with mid to large size Healthcare companies involved with expansion goals.

Extensive experience in the development and implementation of health plan benefits, innovative evidence based disease state management programs, clinical workflows and associated IT platforms

Worked with and served as primary point of contact to high-level executives within regional and national health plans, employers and pharmacy benefits management companies

Proficient in Microsoft Office applications (Word, Excel, Outlook, Office)

Healthcare Benefits Implementation, Event Driven Process Chain Diagrams (EPC) and Testing

Ability to build and facilitate effective team work among cross functional teams

KEY COMPETENCIES

Medicare Strategic Consulting Business Analysis

Formulary Management Benefits Implementation Utilization Management

Disease State Management Pharmacy Operations Regulatory Compliance

Drug Utilization Review Drug Cost Optimization

Patient Safety Medication Therapy Management

PROFESSIONAL LICENSES & MEMBERSHIPS

State Pharmacist License

American Pharmacists Association

WORK EXPERIENCE

HEALTHCARE CONSULTANT (Business Analyst) September 2014 – Present

Cognizant Technology Solutions, Irving TX

Identify and provide awareness of client’s business issues and linkage to healthcare application tools. Apply healthcare expertise to solve client concerns and identify opportunities and challenges

Provided business analysis expertise within an assigned business unit/area, usually as a member of a project team, in the analysis, design, and development of pharmacy systems and claims adjudication systems

Requirements elicitation, analysis and documentation for Cognizant’s healthcare clients by conducting interviews

Formulating and defining application scope and objectives, and devising and modifying procedures to solve business problems

Health Benefits Implementation Project (Health Plan and PBM Client):

Coordinated requirement gathering sessions to understand Health Plan Benefits Design, Formulary and UM

requirements from stakeholders (Benefits Relationship Managers/Clinical Advisors)

Served as a liaison to improve Business and IT alignment by providing support during the design, development and testing phases

Benefits testing requirements analysis, test design, defect management and validation

Custom clinical (Formulary and UM) claims testing tools development and automation

oMapping member’s plan to the contracted formulary program and the ability to define a three tier formulary structure in the clients CRM system

oSetting up separate prior authorization drug list in the clients CRM system and mapping it to the appropriate prior authorization program

Business Rules Extraction Project (PBM Client):

Assisted with business rules extraction for the specialty drugs pricing and distribution module in Claims Adjudication System

CLINICAL PHARMACIST September 1996 – June 2014

ESI/Medco (Mail Order Pharmacy), Irving, TX

Prescription entry and verification with a team of pharmacists and technicians in a call center environment

Offered counseling to patients on medication uses, administration, adverse drug reactions (ADR) and drug interactions over the telephone

Served as appeal clinical pharmacist to determine drug coverage (Evidence based Disease State Management Program)

Documented and reported prescription entry and verification errors to the legal department and resolved them in compliance with Texas State Board of Pharmacy

Assisted customers and doctors with medical billing, diagnosis codes and prior authorization

Assisted in the processing of Medicare and Medicaid insurance claims in accordance with Health Insurance Portability and Accountability Act (HIPAA) and CMS regulations

Provided doctors and patients with cost effective drug alternatives based on the customer’s prescription drug plans

Interviewed customers and identified specific healthcare gaps

Reviewed customer complaints and initiated solutions in an effective and timely manner

CLINICAL PHARMACIST October 2013 – July 2015

DNAstat, Addison, TX

Evaluate cytochrome P450 lab panel results for cardiovascular risk and thrombosis

Analyze current medication for effectiveness and dosage as reflected by results of the P450 panel and recommend alternative medications or dosage modifications

Conducted employee performance reviews on a quarterly basis, identified staff development needs and submitted performance appraisals to the district manager

CLINICAL PHARMACIST December 1993 – July 1996

Baylor University Medical Center, Dallas TX

Responsible for achievement of patient service,, and adherence to professional practices

Effectively compounded and dispensed medications

Evaluate IV admixture for incompatibilities

Trained technicians in the processing of sterile technique

Participate in Drug Study protocol

EDUCATION QUALIFICATIONS

Bachelor’s Degree in Pharmacy from University of Kansas, Lawrence Kansas

Participated in two hospital rotations in nephrology and oncology

Group II Health

CLU I, II, III

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