Summary
Overview
Work History
Education
Skills
Timeline
Generic

Angel Wynia

Dallas,OR

Summary

Experienced healthcare professional seeking a challenging position to leverage extensive background. Passionate about making a meaningful impact in the industry and eager to contribute expertise and drive to a dynamic team. Committed to delivering exceptional patient care, with a strong understanding of healthcare regulations and excellent communication skills. Ready to take on new challenges and contribute to the success of an organization dedicated to improving the well-being of individuals.

Overview

27
27
years of professional experience

Work History

Medicaid Policy

Oregon Health Authority
02.2007 - Current
  • Hospital Policy Analyst (March 2011 – Current)
  • MMA Pharmacy Coordinator (August 2007 – March 2008)
  • Drug File Coordinator (February 2007 – August 2007)
  • Duties include oversight of four programs, hospital, provider tax, transplants and end stage renal.
  • Analyze, interpret state and federal laws.
  • Contract administrator for in-state and out-of-state transplant contracts for fee-for-service and coordinated care organizations and several intergovernmental agreements.
  • Manage administrative rules and state plan for provider tax, hospitals, transplants and end stage renal.
  • Maintain and update reimbursement for hospitals on a quarterly and annual basis.
  • Oversee supplemental payments, such as graduate medical education, disproportionate share and qualified directed payments to the hospitals.
  • Project manage new programs and policies from newly passed legislation.
  • Oversee new high cost drug program for Oregon Health Plan.
  • Legislative duties monitor and track bills, bills analysis and legislative concepts.
  • Work with Secretary of State on audits that impact programs and other contracted auditors.
  • Bi-weekly meetings with internal and external partners.
  • Update MMIS claims system with new fee-for-service reimbursement rates on a quarterly and annual basis.
  • Advise leadership on policy issues that impact Medicaid programs, by creating policy papers to help outline issues.

Trainer

Regence Blue Cross Blue Shield
11.2001 - 02.2007
  • Writing procedures and documentation for all Government Programs Membership staff following Company, State and Federal guidelines and regulations in regards to medical and prescription benefits.
  • Train all new and existing staff on policies and procedures.

Membership Administrator

Regence Blue Cross Blue Shield
11.2001 - 02.2007
  • Loading new and existing member applications, process & reconciles cash batches from members and Social Security, Reconciled retiree groups, Worked Reply & HCR from CMS.

Medicare Claims Analyst

Regence Blue Cross Blue Shield
11.2001 - 02.2007
  • Analysis and evaluation of payer and electronic submitted provider claims.
  • This includes medical, DME, and vision claims.
  • Investigation and administration of all contract benefits accurately and appropriately.
  • Verify eligibility, prior authorizations and referrals.
  • Coordination between departments and organizations.
  • Maintain HIPPAA privacy and confidentiality information.

Pharmacy Services

Regence Blue Cross Blue Shield
11.2001 - 02.2007
  • Investigate and resolve all prescription drug program issues, such as benefits, procedures, claims payment, pharmacy billings, eligibility problems, and denials of coverage for Medicaid, Medicare, OMIP, OHP and private health insurance plans via phone and written correspondence.
  • High level of computer proficiency.
  • Work extensively with patients, providers, agents, pharmacies, and hospitals among others to analyze, evaluate, and resolve issues or problems.
  • Coach and train employees.
  • Research and investigate grievances.
  • Investigate and resolve all employee prescription drug issues maintaining confidentiality and using discretion.
  • Work with pharmacy formularies and pricing concepts.
  • Online benefit restrictions project: coordination with drug utilization review; add and update coding with the Pharmacy Benefits Manager (PBM) to limit patient access to specific doctors or pharmacies per clinical pharmacist review and recommendation due to abuse.

Administrative Assistant

Willamette ESD
11.2000 - 11.2001
  • Maintained facility coordinator's calendar, office files and scheduled meetings as requested.
  • Composed and prepared letters, purchase orders and other correspondence.
  • Ability to plan, organize and coordinate assigned tasks in a timely manner.
  • Maintained maintenance records for all school buses, worked as a liaison between Facility Coordinator and Architects, Project Managers when jobs were in progress.
  • Organized SB1149 meeting and trainings for schools across Oregon.
  • Regulated and organized records for all the home schooled children in the three counties and attended meeting with the State of Oregon regarding homeschooling rules and regulations.
  • Responded to calls and building maintenance issues within the ESD.
  • Coordinated and conduction safety meetings and building inspections.

Pharmacy Services

Regence Blue Cross Blue Shield
07.1998 - 11.2000
  • Investigate and resolve all prescription drug program issues, such as benefits, procedures, claims payment, pharmacy billings, eligibility problems, denied coverage and preauthorizations.
  • This involves intensive phone work and high level of computer proficiency.
  • Able to rapidly access during phone call with member, provider, agent or pharmacist, the question, problem and take appropriate action to resolve the issue.
  • Helped train new employees on phones and claims.
  • Help create and maintain project with the State of Oregon for OMIP members who had high dollar drug expenses; project involved making sure member received medications on a timely manner and at no cost.
  • Recovery project: when members used their benefit after it termed, we would seek reimbursement for money paid out, project involved taking call from angry, upset members, research and investigation, working with pharmacy's and internal departments.
  • Employee claims: investigated and resolved prescription drug issues that came from internal Regence employees, required high degree of confidentiality and discretion.
  • Responded to Grievances from members and providers, research and investigate problems and notifying member or provider of decision in writing and verbally.

Education

Nursing

Chemeketa Community College
Salem, OR

Skills

  • Friendly, positive attitude
  • Teamwork and collaboration
  • Customer service
  • Problem-solving
  • Attention to detail
  • Time management
  • Flexible and adaptable
  • Dependable and responsible
  • Multitasking
  • Excellent communication
  • Critical thinking
  • Organizational skills
  • Calm under pressure
  • Active listening
  • Organization and time management
  • Decision-making
  • Problem resolution
  • Verbal communication

Timeline

Medicaid Policy

Oregon Health Authority
02.2007 - Current

Trainer

Regence Blue Cross Blue Shield
11.2001 - 02.2007

Membership Administrator

Regence Blue Cross Blue Shield
11.2001 - 02.2007

Medicare Claims Analyst

Regence Blue Cross Blue Shield
11.2001 - 02.2007

Pharmacy Services

Regence Blue Cross Blue Shield
11.2001 - 02.2007

Administrative Assistant

Willamette ESD
11.2000 - 11.2001

Pharmacy Services

Regence Blue Cross Blue Shield
07.1998 - 11.2000

Nursing

Chemeketa Community College

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Angel Wynia