JAVERIA SHEIKH

MEDICARE ANALYST/PTCB CERTIFIED

347-***-****

ad15oa@r.postjobfree.com

MINEOLA, NY

OBJECTIVE

To compose the growth of organization and develop within its horizons. To maximize quality of care in the health and hospital industry by means of superior administrative support. To contribute to a team as a professional who serves the needs of a diverse organization, while gradually increasing my role over time and to ensure maximum customer satisfaction.

SKILLS & ABILITIES

Expertise in editing for grammar, syntax, spelling, and punctuation, with a keen eye for detail and the ability to maintain the author's voice and intent. EXPERIENCE

April 2019 – December 2023 Medicare Part D Supervisor, Lake Success, NY AgeWell New York

Review Daily Transaction Reply Reports (DTRR) and the Monthly Membership Reports (MMR) while abiding by Federal Centers for Medicare and Medicaid Services guidance (CMS).

Work with Pharmacy Benefit Manager and vendor partners on Part D operational and oversight functions of AgeWell New York.

Reconciliation of all daily, weekly and monthly Medicare reports generated from CMS.

Perform ongoing monitoring functions (daily, weekly and monthly) of Part D internal and delegating activities to meet compliance requirements and identify risks, remediate issues. Track and report results. Includes, but not limited to transitional fill notification, monthly call log reports, EOB’s, PDE reports, retroactive LIS reports, and rejected/paid claims review.

Directly respond or support a response to inquiries that are rapid and professional to internal and external customers.

Ensure monthly that all identified discrepancies resolutions were met with CMS timeframes.

Actively participate in the quarterly DOC (Delegated Oversight Committee) with compliance to ensure the CMS standards were met and if not, the steps taken to ensure the establishment of new processes, root cause analysis, and corrective actions.

Training, coaching, mentoring, and developing new Medicare Part D Analysts.

Coordinate with Stars team on Part D Star metrics. Strived for a 5- star rating in all Quality Measures, with a special attention to Statins.

August 2018 – April 2019 Pharmacy Technician, Great Neck, NY Onco360 Specialty Pharmacy

Part of the inbound team

Setting up deliveries for Oncology patients.

Database maintenance and updating profiles in accordance with the guidelines.

Directing phone calls to the specified departments.

Also make phone calls to doctor's offices to request new prescriptions.

November 2014 – May 2018 Senior Pharmacy Technician, Fresh Meadows, NY Queens Medical Associates

Intake new patients, creating a complete profile including their current medication and diagnosis.

Calling daily from 5-10 prior authorizations on any given day for patients starting new oral oncology medications or specialty injections and for reauthorizations.

Answering 40+ phone calls a day, setting up deliveries for refills, calling patients for refills, and resolving any issues or directing them to the proper personnel.

Following up with deliveries to make sure patient received the medications and mailed back the confirmation letter signed.

Setting up patients for Celgene products and getting authorization for Revlimid and Pomalyst patients.

Analyzing the flow sheet and requesting medication for patients getting new treatments or continuing IV treatments.

Directing patients to our financial counselors to help with copays or see if they are eligible for free drug.

October2007 - September 2014 Senior Pharmacy Technician/Manager, Carle Place, NY Maple Pharmacy Inc.

Training and certification requirements of other technicians according to HIPAA.

Ordering and stocking of prescription and OTC drugs, including CSOS ordering of controls.

Supervising the workflow according to the pharmacist, prepared labels and filled close to 150 prescriptions a day.

Resolved insurance issues within regard to prior authorizations needed for certain claims and resolved DUR issues.

Kept the current data up to date regarding any changes with our clientele demographics, allergies, discontinuation of meds, etc.

Directed patients to the pharmacist for any questions or concerns regarding their medication.

Billing DME products such as hospital beds, walkers, commodes, wheelchairs, etc. through Medicare Part B.

Custom ordering DME supplies for clientele or directing them to other local pharmacies if an item was not available by our wholesalers.

Reviewing and renewing contracts yearly with PBM's and submitting MAC reviews for proper reimbursement of claims.

Providing excellent customer service and satisfaction. March 2009 – November 2009 Billing Department Supervisor, Lake Success, NY CareMed Specialty Pharmacy

Data entry, handling and processing reimbursement claims, co-pay assistance, managing the fax queue.

Administrative support: incorporating practices within the department to maintain order and hierarchy to maintain workflow.

Reorganization of the intake department, liaison between the pharmacy and billing department to ensure safe pharmacy practice.

5-10 prior authorizations a day of specialty drugs from insurance companies as directed by MD.

Supervision of 8-10 employees in accordance with their schedules, days off, holidays and vacation.

Responsible for dealing with issues between the account representatives and MD offices with any issues and delays in approval of specialty drugs.

EDUCATION

August 2003 B.S. in Health Services Administration St. John’s University

October 2014 PTCB Certification

Certificate #10064203

SKILLS

Knowledge of Pioneer, OncoEMR, Micromerchants, and Therigy systems, Medical Terminology, Root Cause Analysis, SharePoint, Microsoft Word, Excel, PowerPoint, Windows, Netscape, and Internet Explorer.

Knowledge of Medicare Part B, Part D, Medicaid HMO's billing, deductibles, caps, and coverage gaps. Knowledge of oral oncology medications.

Typing speed: 70 wpm

Fluent in English, Urdu, Hindi, and can speak conversational Spanish. Ability to multitask and supervise personnel.

Confident, articulate, and excellent communication skills.

*References available upon request

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