Overview
Work History
Education
Skills
Certification
Timeline
Generic
Amber Voellinger

Amber Voellinger

Moundsville,WV

Overview

14
14
years of professional experience
1
1
Certification

Work History

Pharmacy Account Management, Manager

The Health Plan
07.2023 - Current
  • Manage the pharmacy plan administration team with benefit requests, plan design implementation, termination and data transfer requests and escalated issues to ensure successful claims readiness.
  • Complete internal mapping of prescription drug plans and work with PBM to assure correct benefits are applied for Commercial, Self Funded, Exchange and Medicare lines of business.
  • Oversee daily eligibility and accumulator files.
  • Oversite of plan benefit auditing completed to assure claim adjudication is as intended.
  • Generate scheduled and ad hoc reporting requests.
  • Establish cross-department relationships to ensure accuracy and success of all plans and pharmacy administration initiatives.
  • Conduct root cause analysts, gathering data to pin point problem areas within benefit and formulary administration landscape.
  • Show ability to perform claim analysis to find and solve programming errors within PBM software.
  • Guide the plan administration team with audit protocols, benefit validation and core testing processes.
  • Assist internal teams with the development and implementation of new operation controls and pharmacy programming initiatives.
  • Ensure business partner's accountability for the accurate and timely completion of benefit designs and clinical rule/criteria changes.
  • Work in conjunction with PBM to develop, monitor and improve operation controls and pharmacy program initiatives.
  • Develop unit policies and procedures as applicable and ensure their regular maintenance to reflect new practice and guidance.
  • Provider pharmacy operational troubleshooting and resolve issues related to eligibility, claims and benefit setup.
  • Generate and analyze reporting for new and transitioning groups.
  • Assist with development of team goals, providing team support and creating training documents to assist with team growth and development.
  • Proactively educate and provide recommendations to avoid future service issues (benefit, implementation, formulary and product changes).
  • Assist the VP of Pharmacy Services with development of new programs, or changes to improve or provide solutions for current work processes.
  • Coordinate special projects according to Pharmacy's VP general instructions related to more complex and detailed projects.
  • Complete regular testing to assure that pharmacy benefits are compliant with applicable federal and state mandates.
  • Take part in client calls to assist with questions and concerns related to pharmacy benefits.

Pharmacy Benefit Analyst

The Health Plan
04.2019 - 07.2023
  • Completed quality assurance and testing of PBM functions related to claims adjudication, reporting and plan setup.
  • Prepared detailed reports on benefits expenditures, informing management of financial impacts associated with each plan offering.
  • Assist with implementation of new plan setups.
  • Process benefit requests, terminations and escalated issues to ensure successful claims readiness.
  • Conduct root cause analysts to pinpoint problem areas within the pharmacy benefit structure.
  • Work together with PBM to monitor operational controls related to benefit setups.
  • Generated scheduled and ad hoc reporting requests.
  • Tested to ensure benefit setups were compliant with applicable state and federal laws.
  • Troubleshooted and resolved issues related to eligibility, claims and benefit setup.

Certified Pharmacy Technician

The Health Plan
04.2016 - 04.2019
  • Trained new pharmacy technicians on proper procedures and best practices, ensuring consistent quality of service.
  • Answered incoming phone calls and addressed questions from customers and healthcare providers.
  • Completed medication coverage requests through prior authorization criteria and escalated requests to Clinical Pharmacist when requests required clinical review or were not approvable through automated system.
  • Contacted providers to obtain necessary and/or additional information for coverage requests.
  • Resolved and documented coverage request outcomes in PBM's system and communicated decision to physician's office and/or members through verbal and/or written notification in accordance with company policy.
  • Provided verbal verification of member's plan eligibility and applicable pharmacy benefits.
  • Provided requested details to members and pharmacies in relation to formularies and networks.
  • Assist pharmacies in processing prescription claims; reviewed and troubleshooted claims processing issues.
  • Explain appeal and grievance process to member and providers.
  • Handle calls and correspondence after hours when scheduled.

Certified Pharmacy Technician

Wheeling Hospital
04.2013 - 04.2016
  • Answered incoming phone calls and addressed questions from customers and healthcare providers.
  • Calculated dosages, filled prescriptions and prepared prescription labels with absolute accuracy.
  • Counted and labeled prescription with correct item and quantity.
  • Stocked, labeled and inventoried medication to keep accurate record.
  • Communicated with patients to collect information about prescriptions and medical conditions or arrange consultations with the pharmacists.
  • Entered and processed patient's prescriptions into internal system.
  • Solved customer problems in person or over telephone by providing assistance with placing orders, navigating system and locating items.
  • Consulted with insurance company representatives to complete claims processing, resolve concerns and reconcile payments.
  • Restocked pharmacy shelves with current merchandise to drive consistent peripheral sales.
  • Counted, measured and compounded medication following standard procedures.
  • Ordered medicines daily to replenish stock and increase inventory in anticipation of need.

Certified Pharmacy Technician

Kroger
11.2009 - 04.2013
  • Answered incoming calls and addressed questions from customer and healthcare providers.
  • Calculated dosage, filled prescriptions and prepared prescription labels with absolute accuracy.
  • Counted and labeled prescriptions with correct item and quantity.
  • Stocked, labeled and inventoried medication to keep accurate records.
  • Performed various pharmacy operational activities with strong commitment to accuracy, efficiency and service quality.
  • Maintained proper drug storage procedures, registries and records for controlled drugs.
  • Collected co-payments or full payments from customers.
  • Consulted with insurance company representatives to complete claims processing, resolv concerns and reconcile payments.

Education

High School Diploma -

John Marshall High School
Glen Dale, WV
05.2007

Skills

  • Team Leadership
  • Time Management
  • Complex Problem-Solving
  • Data Analysis
  • Excel Functions
  • Drug Classification Knowledge
  • Compliance Monitoring
  • Power BI Tools
  • Multi-Tasking Aptitude
  • Self-Motivated Learning

Certification

  • CPhT - Certified Pharmacy Technician
  • State of WV Insurance Producer License (Accident and Health or Sickness, Life)

Timeline

Pharmacy Account Management, Manager

The Health Plan
07.2023 - Current

Pharmacy Benefit Analyst

The Health Plan
04.2019 - 07.2023

Certified Pharmacy Technician

The Health Plan
04.2016 - 04.2019

Certified Pharmacy Technician

Wheeling Hospital
04.2013 - 04.2016

Certified Pharmacy Technician

Kroger
11.2009 - 04.2013

High School Diploma -

John Marshall High School
  • CPhT - Certified Pharmacy Technician
  • State of WV Insurance Producer License (Accident and Health or Sickness, Life)
Amber Voellinger