Linda Lee

**** ****** ***, ***** ***** Paul, MN *5109

651-***-**** Email: adr67p@r.postjobfree.com

EDUCATION Normandale Community College April 2017-May 2017

Certified Microsoft SQL Server, Bloomington, Minnesota

National American University September 2011-August 2013

Diploma in Healthcare Coding, Roseville, Minnesota

Century College August 2001-January 2003

Coursework toward Radiology Tech. ASS., White Bear Lake, Minnesota

SKILLS System Used:

Office 365 ● Microsoft Office ●InfoPath ●Clinical Review Engine (CRE) ●Lotus Notes ●IBM Notes ● Microsoft SQL Server ● RxClaim ● Management Studio ● Tableau ● ICMP, MARS, GEM, CNS, MSP ● WebStation ●RxMax Production ●Netezza Azure ●Contract and Rebate Database (CaRD) ●ECG QuickConnect ●Five plus years of leadership ●Strong verbal and written communication skills● Strong analytical skills (problem solving, critical thinking)

EXPERIENCE UnitedHealth Group-Optum, Eden Prairie, Minnesota April 2021-Current Operations Finance & Accounting Analyst

Solves moderately complex problems and/or conducts moderately complex analyses

Prepare insightful monthly financial and business performance reporting for management

Researching variances and payment disputes for short pay/ overpay/ credit to pharma or Optum

Create detailed operational and financial forecast and budget models that inform short terms/ long term business initiatives

Collaborate with Business Analyst on payment forecast and past due accounts

Resolution issue may require working with the manufacturers, billing, and accounting.

Applied incoming payments to manufacturer accounts correctly and timely.

Upload Exclusion reports weekly, research no match rejected claims

Collaborate closely with Rebate Analyst daily on invoice, rejected claims, and formulary

Perform Ad Hac Projects and provide training

Prime Therapeutics, Eagan, Minnesota May 2014-March 2021

Clinical Review Quality Assurance Specialist

Perform complete concurrent quality audits, daily quality monitoring processes for Medicare Part D

Quality review on request drugs, approve and deny prescription drugs by criteria and claims

Quality checks of data entry by Clinical Review Assistants and Pharmacy Technicians urgencies, drugs (brand vs generics) drugs strengths, PHI’s, letters, formulary, GPI and NDC, paid claim, ICD-9, ICD-10, plan code through RxClaim, and provided research to error/ questions

Part of a subject matter expert team to support Clinical review, Coverage Determinations, Duplicate, Redeterminations, Withdraws, AOR, Tolling, Part B vs D, and Member send Back

Ensure compliance with Service Level Agreement (SLA) requirements, standard operating procedures, and Client processes including HIPP/CMA/URAQ/NCQA regulations

Work with supervisor/ manager on special projects update DTP, Ad Hoc Projects, jobs aids, process workflow, Tactical Productivity Report, InfoPath Updates, Status Report to improve current reporting process and tools

Productive finding and error trending using Tableau

Prime Therapeutics, Eagan, Minnesota January 2020-October 2020

Clinical Review Workforce Management Admin (Mentorship)

Identify work volume and make any additional move on agent’s schedule

Review and updated agents PTO and VTO, NICE-Schedule Changes

Work closely with leadership on any updates or processes in IEX/ RTA, and resolve the issue

Work WFM inbox, adjust agents schedule accordingly in IEX from leadership, agents, and Timecard Admin (lunch, break, PTO, OT, VTO, meetings, huddle, training, CIC, production code)

Monitoring Real Time Adherence patterns and report to Supervisors/ Managers

Monitoring CMM, Med D, and Medicaid for TAT cases that need to be address

Run Aging Reports for Queue Update volume for CMM, SI, MedD, Medicaid, and CORE

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