worked on claims for Medicaid-Medicare-Commercial and workman's comp
Resume:
Michelle Muniz -Alston
Philadelphia PA 19152
***********************.**@*****.***
I am seeking employment with a company where I can use my talents, and skills to grow and expand the company. I am bilingual and speak write and translate English to Spanish.
EMPLOYMENT
July 2021-Present Moravia Health, Philadelphia PA
Home Health Aide
•Provide Basic House keeping
•Provide hygiene Assistance
•Provide Incontinence Care
•Medication reminders
•Meal Preparation
•Performed laundry care
•Grocery store and Pharmacy runs
May 2017 - May 2022 RELATED, Dallas Texas
Leasing Agent
•Specialized in resident retention
•Performed residential verification
•Facilitate renewal and recertification process for all residents
•Maintained accurate wait and transfer lists; review applicant files to determine eligibility.
•Utilize your organizational skills and experience to provide the preeminent affordable housing accommodations in the community.
•Maintain leasing and marketing reports as needed
•Supported site and office operations as assigned by manage.
May 2014 – November 2016 PerformRx, Philadelphia, PA
Pharmacy Benefits Claims Analyst
•Subject Matter Expert (SME) Claims Processing/ Plan Benefits
•Identify Root cause, and resolution for all claims processing issues for multiple clients/LOBs
•Responsible for claims service standards
Maintained knowledge of Medicare and Medicaid-related benefit designs,
•Performed Implementation testing for New and Renewing Business
•Provided consultative oversight for testing, maintenance, and upgrading of claims processing system
•Development of action plans for process improvement
•Development and execution oversight of Business Requirement Documents
•Ensuring projects are completed in a timely manner, escalating if necessary
June 2011–May 2014 Health Partners, Philadelphia, PA
Pharmacy Analyst
•Work with vendor to implement benefits and modifications for all lines of business (Medicare, Medicaid, CHIP)
•Ad Hoc Reporting
•Trend analysis of pharmacy utilization for formulary compliance
•Support department with questions in regards to claims processing and resolution
•Testing of benefits prior to implementation
•Formulary change review and analysis
Pharmacy Rebate Analyst & Recipient Restriction Coordinator April 2008 – June 2011
•Support applicable requirements with regulations for rebate postings
•Quarterly rebate invoicing
•Contract review and analysis (determine plans market share for specific contract performance)
•Reconciliation of rebate receivables and ensure proper posting to product line
•Assisted in strategic planning based on performance analysis
•Data analytics
•Oversee Recipient Restriction Program (identify and address inappropriate pharmacy utilization)
Pharmacy Technician June 2001 – April 2008
•Answer calls within 30 seconds
•Prior authorization processing to include working with customers and physicians to ensure the proper administration of drug plans
Complaint & Grievance Coordinator July 2000 – June 2001
•Intake and tracking of Medicaid & CHIP complaints and grievances
•Follow up to include pharmacy, prescriber, and member outreach
•Coordinated Medical Director review
•Weekly, monthly, and quarterly reporting
Contact this candidate