SHONFONYA DIONNE HARRELL

734-***-****

shonfonyadharrell@gmail

SUMMARY: Pharmacy/ HealthCare Professional with over twenty (20) years of experience in Outpatient/Inpatient Pharmacy Services, HMO, Medicare medical and pharmacy claims processing and review, Coverage Determinations, Appeals and Grievances, CMS Medicaid/ Medicare Guidelines, NCQA Accreditation processes, Plan Audits looking to continue to grow in healthcare knowledge and serve people. SKILLS:

● Experienced facilitator of training, meetings and recording meeting minutes

● Knowledge of reporting drug risk analysis, poly pharmacy, medication therapy management

● Skilled in Commercial and Medicaid/Medicare processes

● Project Management and ability to prioritize /multi-task

● Ability to lead, plan, organize, direct, and manage projects.

● Ability to develop, lead and contribute to process improvement projects.

● Excellent communication skills with the ability to understand, interpret, and communicate ideas.

● Strong familiarity and use of existing software packages (Access, Adobe Pro, PowerPoint, Excel, Word, etc.).

● Critical thinking, problem solving

● Ability to effectively interface with employees at all levels. PROFESSIONAL

EXPERIENCE:

04/2023 to 9/2023 Landmark Health (w United Healthcare) Associate Pharmacy Coordinator

● Responsible for maintaining and restocking medications and supplies for providers in assigned territory

● Organize and maintains a consistent stock of inventory by ordering and receiving stock

● Ensures accuracy of the digital vs the physical inventory on hand

● Ensure provider compliance by tracking medication and supply usage and documentation

● Maintain a medical refrigerator, document daily temperatures, and download temperature reports. Provide support to the market during annual flu campaign

● Provide support to the pharmacist and market pharmacy team for clinical pharmacy programs by completing phone calls, faxing patients, providers, pharmacies and/or health plans

● Call and follow up with patients as directed by the pharmacist and will relay findings to pharmacist

● Contact and follow-up with community providers and prescribers via fax and phone regarding pharmacist recommendations, track status, triage pharmacy fax inbox for responses

● Contact community pharmacies to verify co-pays and/or to investigate medication access issues on behalf of patients

● Educates patients on pharmacy-based rules related to medication resources or assistance program

● Provide support and guidance to patients and the market on medication adherence by actively communicating pill packaging, home delivery, and mail order solutions

● Executes and maintains reports and mail patient education to patients

● Triage incoming Landmark Pharmacy tasks and referrals and track status

● Perform other duties and projects as assigned

09/2021 to 1/2023 Zing Healthcare

Pharmacy Coordinator

● Develops and maintains subject matter related to Medicare Part D topics as it relates to the content in the annual beneficiary materials.

● Responds to inquiries from Customer Service, Care Management and UM to assist in servicing member needs

● Maintains annual required Medicare Part D beneficiary materials for all plans.

● Provides operational support for various processes, including fulfillment of ad hoc member material requests, general member materials support, Star Ratings reporting support, weekly HPMS memo support, and other processes.

● Develops, modifies, and improves business processes and policies.

● Employs a “hands on” approach to issue identification and resolution. Utilizes various tools to proactively monitor data quality.

03/2020 to 10/2021 BCBSM/Blue Care Network Medicare Advantage Clinical Helpdesk Quality Analyst/Trainer

● Create and Train department SOPs

● New hire Training (in person classroom/virtual)

● Helpdesk Team Call monitoring QA

● System case data entry QA

● Coaching and development

● IRE submissions

● Part D Benefits review and counseling

● Overall Member/Provider Team support for Part D Helpdesk Techs 10/2013 to 3/2020 BCBSM/Blue Care Network Medicare Advantage Clinical Helpdesk

● Intake, review and complete all requests for pharmacy coverage determinations.

● Medicare Case preparation for independent review entity related to aged Coverage determination cases (Cases not meeting CMS timeframes).

● Respond to inquiries from Customer Service, Grievance and Appeal and Provider Affairs related to the coverage determinations.

● Grievance and Appeals

● Research best practices and emerging trends in employee education and training

● Maintains strict confidentiality

● Works with minimal supervision

● Measures and evaluates training outcomes and effectiveness of training 12/10 to 12/13 United Healthcare Community Plan

Professional Provider Representative

● Completed Primary Care Physician updates and changes

● Answered telephone customer service for provider offices, hospitals and nursing facilities,

Retrieve and enter faxed, telephoned, and e-mailed medication requests

● Detailed claim status for medical providers

● Complete data entry of authorizations requests for Pharmacy insurance claims

● Act as telephone customer service assistance for patient, pharmacy and physician related to medication rejections in claims systems 01/06 to 12/10 Health Plan of Michigan

Pharmacy Technician II

● Lead Pharmacy Technician

● Facilitate and Coordinate meetings and training

● Maintain departmental meeting minutes, Desk Levels and Policy and Procedure

● Clinical and Administrative Support for Director of Pharmacy

● Daily, weekly, monthly, and quarterly reporting on drug risk analysis, poly pharmacy and ER use

● Data entry of authorization requests for Pharmacy/Medical insurance claims,

● Maintain health plan Medication Formulary updates, ensuring all changes relayed in a timely manner to PBM, Physicians and Members

● Training of new staff on all Pharmacy systems

● Maintain contact with interdepartmental management and clinical staff to determine needs, resolve problems, improve processes, and promote effective drug therapy

● Create and maintain pharmacy/medical reports necessary for the Pharmacy and Therapeutics Committee meetings

● Maintain health plan Controlled Substance Lock-In program

● Educate and assist patients in securing routine and preventive appointments with their primary care physician (PCP) and/or specialist as well as the proper use of network services, proper use of ER services, prenatal care, immunizations, and other services 01/02 to 01/06 Great Lakes Health Plan

Pharmacy/ ER Care Coordinator

● Monitoring of appropriate coverage determinations within the Pharmacy Specialty Injectable and Infusion program delegated to the contracted PBM

● Daily, monthly, quarterly reporting for patient drug risk analysis

● Maintain health plan Pharmacy Formulary updates through on-line services, ensuring all changes relayed in a timely manner to PBM, Physicians and Members

● Managed High-Risk Patient ER/MTM Program

● Facilitate appropriate dis-enrollments due to noncompliance with medical and pharmacy services

● Maintain relationships with management and clinical staff to determine needs, resolve member issues, improve processes, and promote effective drug therapy

● Weekly analysis of Help Desk Telephone Statistics and Patient/Provider Claims Reimbursements, and adhoc reports

● Pharmacy and Therapeutics Committee member

● Resolution of Pharmacy related complaints and grievances in support of the Medical Director/Physician Reviewer

● Training of physicians and pharmacist on procedures and formulary updates

● Assist with telephone customer service for patient, pharmacy and physician related to medication rejections in claims system

● Enter non-formulary medication requests and new patient enrollment data 01/97 to 01/02 CVS Pharmacy

Lead Pharmacy Technician

● Completed payroll and scheduling for pharmacy techs

● Ordered medication stock for various CVS locations

● Processed prescriptions, counting and labeling

● Completed customer service/drop off and cashiering

Contact this candidate