Richard Ed Valila

**** ****** ***, *** *****, CA 95624 916-***-**** adzipn@r.postjobfree.com

Education

UNIVERSITY OF CALIFORNIA, DAVIS SEPT 2005 – JUNE 2007

· Bachelor of Science in Exercise Biology

· Emphasis in Biological Sciences

· Graduated June 2007

SACRAMENTO CITY COLLEGE AUGUST 2002 – MAY 2006

· Associate of Science in Chemistry

· Graduated May 2006

LAGUNA CREEK HIGH SCHOOL AUGUST 1998 – AUGUST 2002

· High School Diploma

· Graduated May 2002

Work Experience

CLINICAL WORKFORCE MANAGEMENT ANALYST ELIXIR SOLUTIONS INC.

ENVISIONRX OPTIONS

OCTOBER 2017 - PRESENT

· Generate daily, weekly and monthly clinical operations staff schedules by utilizing the workforce management tool

· Analyze and manage daily scheduling procedures and schedule changes to ensure effective utilization of department resources

· Report on scheduling and assist when necessary to manage proactive workload scheduling, including approval and denial of discretionary vacation, training and meeting activities

· Conduct agent skill assessments to ensure appropriate delegation of call queues

· Analyze real time workload requirements and call routing and make recommendations to department leaders to improve performance and meet or exceed service level standards

· Monitor daily metric results for coverage determinations queues and reassign agent skill designations for call queue optimization

· Communicate identified daily service level risks to management

· Monitor real time agent work states and alert management on adherence trends

· Generate long-term and short-term strategic planner forecasts

· Analyze historical clinical call center data and agent performance statistics

· Enter and track agents’ time off the phones

· May assist with other clinical, quality and productivity reporting and analysis as required

· Monitor intraday management of scheduling procedures, analysis of real time workload requirements, and routing to manage performance to meet deadlines to avoid auto forwards

· Collect and analyze daily reports including historical performance statistics.

· Work with training and operations to coordinate multi-skill training for existing clinical coordinators.

· Research and support various Workforce Management duties and reports as needed.

· Other duties as assigned

CLINICAL COORDINATOR ENVISIONRX OPTIONS

FEBRUARY 2012 – OCTOBER 2017

· Creating coverage determinations for Medicare Part D and commercial groups

· Assisting with obtaining information for prior authorizations from doctors, pharmacies and members, over the phone and from faxed forms

· Notifying members about the results of coverage determinations for medications

· Creating coverage determinations of medications for insurance members and creating prior authorizations to be faxed to doctors

· Helping to set-up and modify overrides of authorizations for medications of both Medicare Part D and commercial groups

· Obtaining information from prescriber about member’s medication and transcribing information for processing and review

· Perform faxing and proper logging of incoming faxes related to coverage determination and redetermination requests

· Research claim reject messaging associated with coverage determination and redetermination requests for pharmacist review

· Assisting in completing tasks for clients or pharmacists that require obtaining necessary information from prescribers or pharmacist in order to reach a decision for coverage determinations

· Configure coverage determination and redetermination outcomes in the adjudication system, per contract terms or upon client request, after completion of initial review and decision by the pharmacist or client

· Respond to routine inquiries and correspondence regarding coverage determinations and redeterminations with members, providers, and pharmacies as applicable for specific clients and log all communication in the customer service tracking module

· Scan and file electronically all paperwork associated with coverage determinations and redeterminations

· Compile data/supporting detail for reporting/response to the IRE for Medicare clients

· Compile coverage determinations and redetermination documentation for auditing purposes

· Maintain confidentiality of patient and proprietary information

DATA ENTRY SPECIALIST MAXIMUS CORPORATION, INC

OCTOBER 2011 – DECEMBER 2011

· Assigned to a 2-month contract with Total Clerical Services Inc.

· Organized Medi-Cal applications and entering health information into system database

· Performed quality control that includes validation and verification of medical documents and health forms

DATA PROCESSOR PINELANDS PRESERVATIONS, INC

JANUARY 2011 – SEPTEMBER 2011

· Processing work orders by the banks to manage and maintain foreclosed homes

· Organizing photos of lawn maintenance work done by contractors who perform routine grass cuts and debris removal on properties

· Coordinating and calling contractors while in the field on certain property preservation tasks

SCORE EVALUATOR CTB-MCGRAW-HILL

MARCH 2009 – SEPTEMBER 2009

· Assigned a temporary position for Kelly Services Inc.

· Assign scores to student responses for various content matters

· Scoring projects that include analyzing writing traits and reading abilities of K-

· 12 students and in content subject areas that include reading, language arts, · mathematics, social studies and science

Related Experience

ROP INTERNSHIP AS MEDICAL ASSISTANT KAISER PERMANENTE HOSPITAL

OCTOBER 2001 – MAY 2002

· Attending instruction in learning vital signs, body systems, health education and medical terminology

· Training in a medical facility organization on hospital routine and hospital asepsis

· Duties include organizing and filing specimen slides in Laboratory Department and preparing for and cleaning after patients in the Recovery and Intensive Care Units

· Regional Occupation Program (ROP), Sacramento County Office, Workforce Development Program

· Certificate of Completion of Hospital and Community Health Services

CARDIAC REHABILITATION INTERNSHIP UC DAVIS MEDICAL CENTER OCTOBER 2006 – DECEMBER 2006

· Assisting patients in telemetry-monitored exercise sessions

· Helping patients in monitor hook-up, taking vital signs, helping patients with stretching and strength training routines

· Assist in cardiac rehabilitation programs exercise stress tests including EKG prep, BP measurement, protocol administration and EKG interpretation

· Internship that emphasizes in exercise physiology, anatomy and kinesiology

· Abilities include taking and charting vital signs and measuring blood pressure and heart rate of patients

Skills & Abilities

· Proficient in Microsoft Office software including Excel, Word, PowerPoint and Outlook

· Familiar with general office duties that include faxing, copying, and printing

· Characteristics include being well-organized, time-efficient and dependable

· Ability to work with peers in a team effort environment

· Demonstrated ability to manage multiple priorities and deadlines

· Capability to efficiently complete tasks in a fast-paced environment

· Strong and effective verbal and written communication skills

Contact this candidate