Alison Corrigan

Represent Network Operations and participate in large scale client facing projects, internal cross functional projects, and implementation interactions by providing insight, recommendations, and requirement. Review and execute escalated, new, revised, and non-standard network operations requests; determine RxClaim system set up to ensure claims sequencing is accurate based upon analysis and interpretation for Commercial, Medicare Part D, and LDD Pharmacy programs.

Represent Network Operations by effectively communicating procedures, quality controls and addressing other related inquires during internal and external audits. Perform complex quality reviews of large sets of data and analysis of cases to prevent errors based on strict compliance, service level agreements, and regulatory guidance

Assist in the intake of new projects, business initiatives and process improvements; work directly with assigned business area and consult with various levels across organizations as needed.

Create and deliver informal training for project and process improvements for successful and timely completion of work.

Perform user acceptance testing at a feature level and present new features to users in individual or group settings.

• Configures new commercial and Medicare Part D pharmacy networks within the claims adjudication systems and performs network database maintenance on existing networks. Loads pricing from commercial and Medicare Part D pharmacy contracts into the appropriate adjudication systems with a high degree of accuracy. Performs claims and systems testing to ensure setup of networks and pricing is functioning as expected; research issues with performance and perform updates to setups/pricing as needed if/when issues are detected. Perform quality control analysis of peer configuration setups and pricing loads. Engages other functional areas and departments as needed once configurations have been completed to ensure additional downstream processes can be completed timely. Requests new systems enhancements for increased performance, functionality and efficiency in processing, tests system enhancements and provides feedback on functionality and performance. Assists in training of new coworkers and creating and maintaining performance and procedure documents for use in training and for new and existing processes with an eye towards efficiency

• Assist with credentialing, re-credentialing and file management updates for all providers (PCP/Specialist Physicians, Mid-Level practitioners, and Allied Health Providers) within the organization's CT, MA, NY & RI market areas. Develop and maintain business relationships with national accreditation regulatory and medical credentialing organizations. Oversight of data integrity and supporting documentation for CT, MA, NY and RI network providers. Specializing in optimized production and improved functionality of processes, accuracy of records updates with proven results, top producer in the department.
• Key Contributions: Top production volume in both credentialing and re-credentialing within one month of start maintained to date. Eye for detail, consistently praised for attention to detail and the ability to identify problems and find solutions. Teaching others how to use available tools, resources and systems for improved speed and accuracy in production, sharing methods with teammates for overall improved production and accuracy.

• Single point-of-contact in support of timely and accurate benefit installations; managed and coordinated benefit plan implementation for new and existing customers. Reviewed benefits to ensure compliance with state and Federal legislative mandates; partnered with consultants, brokers, and third-party administrators (TPA) to review plan sponsor benefits and structure. Managed and administered key activities in support of complex account structures and comprehensive benefit plans in systems, meeting internal/external deadlines for production of multiple products and services.
• Key Contributions: Effectively mentored new hires by responding to queries regarding responsibilities and job tools. Served as a key member of development and testing team for new benefits and systems that supported benefit creation. Conducted research on benefit products and services selected by customers to determine if there is support through existing operating platforms. Defined solutions to issues; negotiated crucial requirements in support of non-standard plan selections.

• Provided thorough support and problem resolution for provider network inquiries including policy and procedures education, claims status and adjudication timelines for Pharmacy benefits. Combined research and analysis to resolve claims issues elevated by providers and internal/external customers. Coordinated and communicated processes in each step of the ERA, Electronic Remittance Advise, and EFT, Electronic Funds Transfer, process to facilitate claim payment to providers.
• Key Contributions: Created, managed and maintained the process by which Hemophilia 340B claims were paid properly and timely, resulting in tens of thousands of dollars savings on timely payment guarantees. Establishing correct payment information in the systems by enrolling providers with ERA & EFT, and adding valid demographic data and contact information to maintain timely communications with providers. Created and maintained databases used to track provider information and claims information to facilitate the claims payment process for 340B claims. Reviewed and investigated provider issues and problems with claims denials; created and established as a liaison between providers of service and claims processors for accurate and timely processing and payment of hemophilia 340B claims. Considered provider claim issues Subject Matter Expert; created and maintained training materials and trained coworkers on the new processes.

• Provided high quality, provider relation-focused service, using knowledge of procedures and systems to meet and exceed internal and external customer satisfaction while educating constituents on Aetna policies and programs. Executed intake triage and replied to provider requests and network inquiries including policy and procedures, credentialing status, and provider leads; accountable for delivering support to department members in completing root cause analysis to resolve issues elevated by providers and internal/external customers. Credentialed pharmacies and pharmacists to participate in Aetna Pharmacy Networks, including loading contractual rates, license certificates, education and payment methods for pharmacy claims. Maintained credentialing data integrity between multiple systems.
• Key Contribution: “Innovation in the Workplace” Award for suggesting processes where credentialing production could be increased 6 fold with increased accuracy; taught process to team allowing for completion of project in 2 weeks that was budgeted to take 6 months to complete. Managed the on-going training for coworkers on standard operation practices and appropriateness of requests and precise completion of provider of add/change forms; trained new hires regarding job processes and systems navigation.