Women's Job List: The Job Board for Women

Posted on: 2011-11-27

Professional Experience

The Round Top Collection – Sr. Account Manager November 2009

Responsible for scheduling customers in Houston & the surrounding areas for pick-up on their orders
Customer Service calls regarding damages, issuing credits and replacing damaged product
Back-up Receptionist responsible for phones, faxes and copies
Attend Home & Garden Market shows and sell product for The Round Top Collection, twice a year, January/July in permanent showroom in Dallas
Work The Nutcracker Market, a Charity Event, one time a year in Houston

Houston Eye Associates July 2009-November 2009

Credentialing Coordinator

Responsible for Credentialing & Recredentialing thirty eight physician office, both the main clinic and satellite offices
Responsible for keeping Medicare/Medicaid License updated and current
Responsible also for credentialing for the Houston Hearing Center

Health First TPA, Houston, TX 2007-2009

Pharmacy Benefit Administrator, July 2007

Acted as the liaison between the Member and the PBM (Pharmacy Benefit Administrator). With my access to the PBM’s eligibility, I performed updates to eligibility or added prior authorizations, in the event a member encountered an issue, whereby their prescription was rejected at the pharmacy
Responsible for implementing the ID card process. The ID card process was mocking up each ID card, both medical & dental for each Member. This process included setting up a draft of data information to be used on the ID card
Responsible for mock up, sending ID card to vendor for approval. Vendor would mock up the ID card and send it back for approval. Once approved the ID cards would be printed and mailed out to the Members/Clients
Attended pharmacy conferences and worked closely with several PBM’s. Stayed up-to-date on new drug availability by attending several out of state pharmacy conferences and working closely with the PBM’s.
Worked closely with Account Managers to keep them abreast of cost saving measures for clients, i.e., considering generics first, implementing specialty pharmacy for bio drugs and pill splitting.

Health Administration Services, Inc. 1996-2007

Credentialing Coordinator

Credentialing of approximately 11,500 physicians for our in house PPO network, Premier.
Evaluate provider needs in a specific geographic location or area of specialty and solicited providers as needed
Responsible for maintaining and updating information on these physicians
Scheduled and prepared a credentialing meeting for new physicians twice annually
Accessing the National Practioners Databank; checking litigation on the physicians before presenting to the PPO Board of Directors
Develop, distribute and maintain PPO directories
Responsible for formatting, proofing and setting up the directory for print
Process letters to providers who are referring out-of-network or are not in compliance with claims guidelines
Assist in the maintenance of provider contract files

Health Administration Services, Inc. 1994-1996

Eligibility

Health Administration Services, Inc. 1991-1994

Client Services/Mailroom

Accomplishments

Education

Earlier Career Summary