Charies Harris
Scottsdale,AZ
Summary
Collaborative leader with dedication to partnering with coworkers to promote engaged, empowering work culture. Documented strengths in building and maintaining relationships with diverse range of stakeholders in dynamic, fast-paced settings.
Overview
20
20
years of professional experience
Work History
Manager, Electronic Data Delivery
CVS Health
09.2017 - Current
- System Integrations and Data Exchanges SME for Claims Experience Transmission (CET) files.
- Dedicated manager guiding new customers through a seamless Prescription Benefit Management (PBM) transition
- Build and define technical file requirements for custom claim file.
- Build flat text raw data custom claim files to support client reporting, that contains detail on how each claim paid during the payment cycle.
- Follow National Council of Prescription Drug Programs (NCPDP) standards for claim file format.
- Ensure secure file transfer protocol (SFTP) set up for new and existing business for the transmission of data sets for financial reconciliation.
- Achieved departmental goals by developing and executing strategic plans and performance metrics.
- Enhanced customer satisfaction by resolving disputes promptly, maintaining open lines of communication, and ensuring high-quality service delivery.
- Established robust risk mitigation strategies to safeguard against potential operational challenges or disruptions.
- Mentored team members for career advancement, fostering a pipeline of future leaders within the organization.
- Cross-trained existing employees to maximize team agility and performance.
- Trained team members in custom claim file build and enforced participation in exercises focused on developing key skills.
- Planned, created, tested and deployed system life cycle methodology to produce high quality systems to meet and exceed customer expectations.
- Maintained positive customer relations by addressing problems head-on and implementing successful corrective actions.
- Maintained professional demeanor by staying calm when addressing unhappy or angry customers.
- Work independently while engaging team members in order to meet the high demands of clients.
Sr. Medicaid Encounter Analyst
CVS Health
01.2013 - 08.2017
- Medicaid Encounter Subject Matter Expert for Pharmacy generated Medicaid encounter files
- New Implementation, system upgrades
- Perform research and analysis to meet business and client needs
- Prepare, validate, submit, load, and log 837 encounter files, 277,824, 999, NCPDP response files in accurate and timely manner according to state and federal regulations
- Analyze complex data for trends, highlights in depth interpretations and provide in depth root cause analysis
- Perform ongoing research, and support tasks for existing systems
- Provide workgroup support on projects
- Lead the planning, development and validation of detailed test plans and test scripts
- Gather and document business requirements into specification for system changes
- CVS/Caremark State Medicaid Encounter Department
- Handle pharmacy encounter data for CVSC clients who provide prescription drug benefits to eligible Medicaid members
- CVS Encounter team submits, reconciles and reports pharmacy encounter data in accordance with state and federal regulatory guidance
- All interacting is through the respective Client instead of State Medicaid agencies
- Create outbound files, mapping and generate files for submission to state Medicaid Agencies
- Reconciliation monitor, analyze, corrects, and resubmit encounter data
- Reporting, create summary and detail reporting for internal and Client use
- Project Management, work with Encounter Department, internal partners and clients on implementation and operation relating to encounters
- Submit, reconciles and report p
- Support State Medicaid Encounter Implementations in the initiation, planning, management, and tracking of Medicaid operational, regulatory projects while delivering desired results with agreed timeframe
- Key contact for State Medicaid Encounter and Response file implementations and processing
- Gather requirements to support state file formats to existing and prospective customers
- Set up data exchange delivery for State Encounter Files
- Create and execute deliverables as part of the Outbound Medicaid Encounter team
- Create and submit Medicaid Encounter Files to various state entities in accordance with regulatory and contractual requirements for accuracy and timeliness
- Analyze and verify system results to ensure accuracy, accountability and financial data integrity
- Respond daily to customer inquiries and complaints both verbal and written correspondences
- Analyze and resolve system errors with established timeframes
- Analyze and recommend solutions to non-standard request and requirements and from plan sponsors
- Research, summarize, and categorizing Medicaid Encounter rejects from various states
- Adhere to file submissions and acceptance rates for state Medicaid Encounter files
- Recommend business solutions through research and analysis of file data
- Maintain Medicaid Encounter reports for presentation to management.
- Increased efficiency by streamlining data analysis processes and implementing automation tools.
- Collaborated with cross-functional teams to identify opportunities for process improvement and increased efficiency.
- Streamlined reporting procedures by creating user-friendly dashboards for easy access to key performance indicators.
- Identified trends and patterns in large datasets, leading to actionable insights for business growth.
Enrollment Analyst
CVS Health
05.2007 - 12.2012
- Manage several accounts with daily interaction with clients about file transmissions and discrepancies
- Provide quality service for implementation and management of eligibility relationships
- Research and audit file frequency reports for auditor Ernst and Young
- Interact with internal and external customers with a strong focus on customer service
- Perform data analysis on client files; make business recommendations to improve the integrity of client data
- Complete intense project timelines from account management and clients for enrollment file data clean up
- Provide effective communication to management about client expectations and client file discrepancies
- Strong understanding of eligibility concepts and the enrollment file process
- Resolve client service problems, by effectively communicating required eligibility concepts
- Work independently with clients to add and term records
- Manage the implementation process for new business as well as support changes to existing client files
- Implement and manage the 834 and 160 file layout and process
- Work closely with vendors to transition data to the Recap and RxClaim system.
Lead Eligibility Analyst
Health Net Inc
08.2003 - 02.2007
- Communicated accurate enrollment, eligibility, and benefit information to customers
- Provided administrative support to supervisor in the areas of staff time keeping, backlog, and audit results
- Handled elevated calls and discrepancies before management intervention
- Responded daily to medical benefit inquiries from employer groups, human resources, and legal affairs
- Interviewed and screened candidates for employment in the eligibility department
- Welcomed new employees to the company with presentation and department gift
- Performed daily eligibility audits on accounts to resolve discrepancies
- Interacted with all levels of employees and company executives.
Education
Master’s Degree in Business Administration -
University of Phoenix
12.2002
Bachelor of Science - Kinesiology
California State University, Bakersfield
06.2000
Skills
- Strategic Planning
- Business Development
- Performance Management
Accomplishments
Employee of the Month
Timeline
Manager, Electronic Data Delivery
CVS Health
09.2017 - Current
Sr. Medicaid Encounter Analyst
CVS Health
01.2013 - 08.2017
Enrollment Analyst
CVS Health
05.2007 - 12.2012
Lead Eligibility Analyst
Health Net Inc
08.2003 - 02.2007
Master’s Degree in Business Administration -
University of Phoenix
Bachelor of Science - Kinesiology
California State University, Bakersfield
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