Summary
Overview
Work History
Education
Skills
Timeline
Intern

Berry L Moore

Lancaster,TX

Summary

Knowledgeable and dedicated customer service professional with over 20 years of extensive experience in the PBM industry. Solid team player with an outgoing, positive demeanor and proven skills in establishing rapport with clients. Motivated to maintain customer satisfaction and contribute to company success. Specialize in quality, speed, and process optimization. Articulate, energetic, and results-oriented with an exemplary passion for developing relationships, cultivating partnerships, and growing businesses.

Overview

23
23
years of professional experience

Work History

Associate Provider Installation

OptumRx
10.2021 - Current
  • Identify and configure necessary additions, changes, and deletions to new and existing configuration designs.
  • Processing and/or auditing ACTs (Add, Change and Terms), database maintenance, reporting and extracting data for various reports and initiating database improvement.
  • Maintains current provider data to ensure the quality of the network
  • Maintains standards for database integrity and quality assurance, coordinates corrective activities to clean database and retain users, and manages communication processes with other departments regarding database improvements.
  • Perform data entry into FACETS, NDB & COSMOS management system. And other Microsoft Applications (Access, Excel, etc).
  • Maintain Production and exceptional quality standards.
  • Ability to troubleshoot complex system configurations.
  • Identify problem areas with system design and follow up with ideas for resolution.
  • Organized and maintained 5 state-assigned workload.
  • Sought ways to improve processes and services provided.
  • Proven ability to learn quickly and adapt to new situations

Associate Business Analyst Commercial Formulary

OptumRx
02.2019 - 07.2020
    • Responsible for formulary builds and maintenance covering all Commercial, Medicaid and Exchange lines of business
    • May be responsible for commercial formulary program creation & maintenance in the formulary application
    • Support short and long term operational and strategic business activities - by developing, enhancing, and maintaining operational information as well as supporting development and maintenance of the Formulary Management applications
    • Ability to apply clinical knowledge to drug programs and their implementation into formularies
    • Review and analyze formulary data to determine the appropriate process for building and maintaining formularies in the Formulary Management applications
    • Oversee formulary change process and perform formulary reporting and analysis functions
    • Work collaboratively with others to track and maintain formulary information for specific clients
    • Ensuring a comprehensive quality review of formulary data to maintain accuracy and service level agreements
    • Working on various large NPI and GPI change projects
    • Exercised critical thinking to resolve coding errors.
    • Applied honed problem-solving skills to analyze and resolve issues impacting business operations and goal achievement.

Benefit Analyst II

OptumRx
02.2014 - 02.2019
    • I was responsible for the installation of assigned accounts, including but not limited to structure building, revisions, researching and resolving structure issues, database loading, and maintaining an assigned book of business.
    • Also responsible for reviewing, analyzing, and implementing desired plan benefit features including formulary loads and performing quality assurance checks by testing claims against the desired benefit design.
    • Ensures accurate claim processing by communicating discrepancies found in set-up and/or quality assurance testing and recommends appropriate plan set-up changes and/or system modifications when required.
    • Coordinates with internal and external customers to ensure the documentation, implementation, and modification of benefit plans is completed on a timely basis and is updated according to Optum policy and legal requirements.
    • Was the lead coder on multiple implementations
    • Lead coder taking client calls to resolve member issues.
    • Responsible for researching, testing, and responding to inquiries regarding system capabilities and system problems related to plan benefit design from other internal departments such as Client Services, Account Management, Eligibility, Member Services and Quality.
    • Review and interprets benefits information and language from client's source of truth documentation.
    • To input into Rx Claim for designated accounts.
    • I have the ability to handle large volumes of task and able to source task/prioritize multiple projects at one time; and meet or exceed team metrics for production.
    • I am able to research installation issues & develop customer specific resolutions.
    • Setup client conference calls and calls with the implementation manager to resolve impending issues and to provide implementation status
    • Work as the lead coder on multiple implementation projects working very closely with the implementation manager and client.
    • Assisted with design and implementation of various employee benefits programs.
    • Skilled at working independently and collaboratively in a team environment.
    • Proven ability to learn quickly and adapt to new situations.
    • Worked well in a team setting, providing support and guidance.

Senior Testing Analyst

Express-Scripts
01.2013 - 01.2014
  • Lead group discussions to gather requirements and translate business objectives into functional design
  • Analyze and interpret data, monitor performance metrics, and suggest business and/or process improvements using root cause analysis, data mining manipulation, and best practices
  • Work with team to design setup and maintain end-to-end test scenarios and execute tests
  • Lead and coordinate internal team projects
  • Attend client meetings and create custom test cases when applicable
  • Considerable cross-functional communication to effectively monitor the daily status of client implementations and assist in collaboration efforts with internal partners to obtain necessary information
  • Relationship building and daily partnership with Implementations and CBA(Client Benefit Analyst)
  • Manage new and existing client testing to validate benefit set-up based on clients' intent and expectation
  • Troubleshoot and resolve issues in a timely manner to meet effective dates
  • Execute a project plan and communicate results in a client/vendor-facing environment when applicable
  • Kept scripts and test cases updated with current requirements.
  • Create and maintain client-specific documentation related to benefit validation.
  • Documented testing procedures for developers and future testing use.

Client Benefits Analyst

CVS/CAREMARK
01.2011 - 01.2013
  • Analyzes client benefit requests and determine the best operational approach to perform coding
  • Preformed QA by validating coding accuracy via the use of various resources in order to ensure there is not a negative financial impact to the company, or client/member dissatisfaction
  • Generates reporting which provides confirmation that the client intent has been met
  • Interacts directly with the client and internal partners in the design, research, and resolution of benefits issues
  • Consistent in meeting and exceeding expected turnaround times and quality standards
  • Mentored new hires and less tenured members of the team
  • Preformed quality assurance for coders maintaining a 99% accuracy rate
  • Preformed queries and multiply test scenarios to verify and compare work accuracy
  • Conducted weekly inventory calls.

Client Benefits Specialist

CVS/CAREMARK
01.2009 - 01.2011
  • Responsible for the accurate coding and testing of client's PBM benefits
  • Responded to inquiries from internal partner regarding client's plan benefit set-up
  • Research benefits set-up issues and proposed appropriate solutions.

Web Support Representative III

CVS/CAREMARK
01.2005 - 01.2009
  • Guided members through the utilization of the CVS/Caremark website in order to access their prescription benefit information, and track mail order status
  • Responded to telephone inquiries from members regarding problems accessing or errors in member information that appeared on the website
  • Partnered with internal sources to identify root causes of member's issues and provided prompt, accurate, resolution
  • Also acted as a lead and mentor for new and less tenured representatives.

Customer Care Representative

CVS/CAREMARK
01.2001 - 01.2005
  • Responded to telephone inquiries from members regarding their prescription benefits
  • Assisted members with prescription refills, and order tracking, and provided information on plan benefit set-up
  • Tracked and identified trends and proposed suggestions
  • Met and exceeded member expectations by providing superior levels of service
  • Supported the internet research team.
  • Responded to customer needs through competent customer service and prompt problem-solving.

Education

Certificate in Auto Mechanics -

Area Vo-Technical School
1991

High School Diploma - undefined

Wyandotte High School
1990

Skills

  • Microsoft Office, Word, Excel, PowerPoint, Outlook, Access
  • Salesforce, AS400, RxClaim, COSMOS, Facets, NDB
  • Problem-Solving
  • Client Relations
  • Analytical and Critical Thinking
  • Data Entry
  • Attention to Detail
  • Organization and Time Management
  • Self-Motivated

Timeline

Associate Provider Installation

OptumRx
10.2021 - Current

Associate Business Analyst Commercial Formulary

OptumRx
02.2019 - 07.2020

Benefit Analyst II

OptumRx
02.2014 - 02.2019

Senior Testing Analyst

Express-Scripts
01.2013 - 01.2014

Client Benefits Analyst

CVS/CAREMARK
01.2011 - 01.2013

Client Benefits Specialist

CVS/CAREMARK
01.2009 - 01.2011

Web Support Representative III

CVS/CAREMARK
01.2005 - 01.2009

Customer Care Representative

CVS/CAREMARK
01.2001 - 01.2005

Certificate in Auto Mechanics -

Area Vo-Technical School

High School Diploma - undefined

Wyandotte High School

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Berry L Moore