Andrea E. Ruperto

**** ********** ***, *** *** Winter Park, FL 32792 407-***-**** ad1bhj@r.postjobfree.com

Objective: To obtain and maintain a stable position at a certified clinical establishment, that will allow me to improve professionally as well as to help the company grow as a whole.

Summary of Qualifications:

An accomplished, well-organized, patient-oriented candidate with 13+ years of a broad spectrum of pharmacy experience and 2 years of business analyst experience. Throughout my career, I have consistently established integrity, quality, and professionalism to provide organizations/clients with a broad array of services composed of drug dispensing, computer drug order entry, insurance investigation and adjudication, appeal case management, patient care coordination, data aggregation, and much more - filling multiple positions across the board from main operations to team leadership. With the additional experience of being a senior professional business analyst on the training and modeling team, I consider myself to be a well-rounded candidate.

Skills and areas of expertise include:

●Fluent in both the English and Spanish languages in all aspects.

●Strong willed and dependable individual that tends to absorb information quickly and accurately.

●Able to develop relationships with management and facility staff.

●Perform or assist with any operations, as required to maintain workflow and to meet schedules and quality requirements.

●Answer phone calls from different entities & aid as needed.

●Ability to maintain self highly organized with superior attention to detail.

●Uphold a professional atmosphere

●Competent with all Microsoft Office applications, CPR+, and other EMR programs, ProVision, Knowledge Exchange, and Adobe Captivate

●Retain strict confidentiality

●Exude exemplary customer service skills

●Participate in any variety of meetings and work groups to integrate activities, communicate issues, obtain approvals, resolve problems and maintain specified level of knowledge pertaining to new developments, requirements, and policies.

●Perform other related duties as assigned accurately.

●Strong interpersonal skills to interact with customers and team members

●Strong communication skills

●Strong technical writing skills

●Strong analytical and problem solving skills

●Good presentation skills to present to management and customers

●Good personal computer and business solutions software skills

●Ability to work in a team environment

Willingness to travel

Work History:

April 4, 2022 - Present – Gainwell Technologies, Inc

Remote

Position: Senior Professional Business Analyst on Training and Modeling Team

Duties:

Analyzes and documents client's business requirements and updates baseline business process models to reflect the to be solution. Provides input to support requirements and design documentation for implementation projects. Supports meetings with clients to validate requirements and identify gaps in proposed solutions. Assists with publishing business process models to Knowledge Exchange (KE). Delivers onsite and virtual instructor lead training on the Gainwell Medicaid Enterprise System components. Supports operations/site staff training and preparation of go-live. Webinar and/or travel to account sites for in-person training of operational staff may be required. Updates baseline eLearning videos, user manuals, and other training materials that support the Gainwell Medicaid Enterprise System product offering.

October 10, 2019 – July 2022 - PerformSpecialty Pharmacy

2416 Lake Orange Drive, Suite 190

Orlando, FL 32837

Position: Pharmacy Claims Specialist

Duties:

Collect, post and manage account payments. Submit claims, audit claims and follow up with insurance companies. Prepare and submit clean claims to insurance companies electronically or by paper. Audit claims after submission and correct errors. Respond to insurance audit requests in a timely manner. Review month-end reports, revenue, cash and adjustments for accuracy. Answer questions from patients, staff and insurance companies. Identify and resolve patient billing complaints. Prepare, review and send patient statements. Evaluate patient financial status and establishes budget payment plans; monitor and report status of delinquent accounts. Review accounts for possible assignment and make recommendations to the Billing Supervisor; prepare information for the collection agency. Assist patients in locating financial assistance programs for monies due for medications. Prepare daily reports and performs financial system maintenance as required. Perform various collection actions including contacting patients by phone, correcting and resubmitting claims to third party payers. Process payments from insurance companies and prepares a daily deposit. Participate in educational activities and attends monthly staff meetings. Conduct self in accordance with company’s employee manual. Maintain strictest confidentiality; adhere to all HIPAA guidelines/regulations.

June 22, 2015 – October 2019– BioPlus Specialty Pharmacy

376 Northlake Blvd.

Altamonte Springs, FL 32701

Position: Appeal Coordinator

Duties: Responsible for all aspects of clinical appeals. Contact prescribers to request required clinical documentation and ensure all necessary information is on file to complete appeal. Maintain open lines of communication with operational, reimbursement and sales departments. Essential functions include: Initiate and coordinate appeals with prescriber’s offices. Discuss options with prescribers and other healthcare professionals, review clinical information for all appeals by using criteria that is nationally recognized in order to determine the actual necessity of the services that are requested, coordinate and deliver verbal and written information regarding patient and provider appeals, and ensure all letters are in line with all required standards, and staying abreast of treatment guidelines in specialty pharmacy.

Position: Sales Support Specialist

Duties: Responsible for keeping updated reports as instructed by VP of Sales, maintain up-to-date referral source records, as well as any other requested records, in accordance with company instructions, support all Specialty Pharmacy activity in the delivery of medications, i.e. assisting center in procuring missing documentation, and communicating information of and for M.D. offices, etc, communicate all competitive information to VP of Sales and other marketing employees, communicate all information regarding competitors, business threats and relating information for VP of Sales, comply with all company policies and procedures, attend and participate in sales meetings, training programs, conventions and in-services as directed by VP of Sales, notify physicians of patient benefits, triage prescriptions to in-network pharmacy we cannot fill, contact physicians and or patients to obtain necessary information to complete prescription processing, follow up with MD offices to obtain prior authorization status, mail and/or fax out marketing materials as instructed by VP of Sales, answer incoming phone calls for sales staff with courtesy and efficiency by taking accurate messages and/or routing calls properly, fill in for sales staff when they are out of the office, by handling phone calls and tracking their referrals.

March 16, 2015 – June 16, 2015 – US Script

8427 S. Park Cir, Suite 100

Orlando, FL 32819

Position: Pharmacy technician I, Medical Management

Duties: Track and triage coverage determination requests submitted from providers and determine if a pharmacist review is required, Obtain verbal authorizations and request detailed clinical information from prescribers, Approve coverage determination requests based on defined criteria within the scope of approved protocols or decision trees, Enter and document coverage determination request decision into the PBM system and notify providers and/or members, Respond to client inquiries regarding authorization approvals and PBM on-line applications Refer coverage determination requests for specialty drugs to delegated vendor or client for processing, Contact providers for additional information to facilitate coverage determination reviews, Notify physicians, providers and members of coverage determination request decisions.

February 12, 2015 – March 16, 2015 - Davis Marketing Concepts

1912 Boothe Cir.

Longwood, FL 32750

Position: Outside Sales Representative

Duties: Participate in a management training program, manage specific territories for fortune 500 clients, engaging with customers and informing them of the product now available to them through myself and company before mentioned.

August 7, 2013 - February 4, 2015 - Axium Healthcare Pharmacy, Inc. (Specialty Pharmacy)

550 Technology Park, Suite 1000

Lake Mary, FL 32746

Position: Lead Evening Pharmacy Technician

Duties: Data entry, patient care coordination, record keeping, compliance auditing, inventory, and administrative reporting, insurance verification and adjudication, and assistant to inside Physician's Account Liaisons and sales. I have experience with MS, RA, Oncology, Hepatitis, Rheumatoid Arthritis, Crohn’s and IVIG drug orders, making calls to Physician's offices and patients, daily, as needed, following up with a patient's/Physician's order in attempts to achieve the best possible service.

March 5, 2012-August 6, 2013- Balanced Solutions Compounding Pharmacy

550 Technology Park, Suite 1008

Lake Mary, FL 32746

Position: Pharmacy Technician

Duties: Reception, data entry, fulfillment, record keeping, non-sterile compounding, inventory, and administrative reporting, and compliance, and patient/physician order follow up.

Education: Winter Park Tech- Avalon Campus

Orlando, FL

July 14th, 2010- November 2011

While enrolled, completed over 300+ hours of internship within both in-patient and out-patient establishments. (250+ hours at Florida Hospital East and 75+ hours at local retail Walgreens.)

Colonial High School

Orlando, FL

Graduated with honors June 2011

References: Upon request

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