Cristian Taveras-Fabian
Brockton
Summary
Experienced in business, adept at managing payer insight, data analytics, and project management. Possess a wide range of skills and eager to contribute towards improving and aligning the business with its vision.
Overview
19
19
years of professional experience
Work History
Specialty Pharmacy Liaison Supervisor, Patient Access Services
Alkermes, Inc.
05.2023 - 02.2025
- Led and supervised a team of Specialty Pharmacy Liaisons, assigned tasks, monitored performance, and provided coaching and development opportunities
- Set clear goals and expectations for the team to achieve patient access
- Regularly reviewed team performance metrics and identified areas for improvement
- Collaborated with specialty pharmacies to facilitate timely prior authorization approvals for patients requiring Alkermes specialty medication Vivitrol
- Addressed complex patient access issues, including insurance coverage, financial assistance programs, and medication adherence for Vivitrol
- Maintained relationships with key decision-makers at pharmacy benefit managers (PBMs) and insurance companies to ensure optimal patient access to Vivitrol
- Maintained strong relationships with Alkerme’s Market Access and Trade’s team stakeholders serving as a liaison for Patient Access Services
- Addressed escalated payer concerns regarding Vivitrol’s access
- Ensured adherence to all applicable laws, regulations, and company policies regarding patient privacy, data integrity, and practices
- Monitored team activity and generated accurate reports on patient access metrics, and key performance indicators
- Possess a deep understanding of Alkermes specialty medications, including their therapeutic indications, clinical data, and potential side effects
- Stayed current on industry trends, payer policies, and reimbursement landscape related to Vivitrol
- Managed and maintained the listings in the Aristada and Vivitrol online provider locators
Customer Service Supervisor, Patient Access Services
Alkermes, Inc.
04.2018 - 05.2023
- Active in various committees to improve internal programs
- Supervise up to 10 direct reports
- Cross-trained Customer Service Associates to assist other teams within the organization
- Head multiple initiatives within HUB services to support program enhancements and staffing
- Responsible for communicating internal changes for complete transparency by updating SOP and WI
- Data analysis daily to meet business needs
- Lead multiple taskforces to share company-wide changes and support product launches
- Manage service level agreement (SLA) above 95% to support our KPI’s
- Manage and perform user acceptance testing (UAT) on new system process additions and changes
- Report monthly metrics to upper management for consideration for budgeting and staffing
Enrollment Supervisor
Tufts Health Plan
01.2017 - 03.2018
- Company Overview: (fka) Network Health
- Trained, coached, supervised and mentored on both group and individual levels in a team of twelve employees
- Coordinated, delegated, conducted quality checks and audits on daily tasks assigned to Enrollment Specialists
- Investigated complex member discrepancies
- Managed communication between departments and source agencies regarding enrollment and member issues
- Established and implemented new workflow processes and improved existing processes
- Worked closely with the manager to ensure all enrollment policies and procedures were adhered within the group
- Took disciplinary action when necessary, in accordance to Human Resources policies and procedures
- Conducted formal performance appraisals in accordance to company’s mission, vision and values
- (fka) Network Health
Provider Audit Analyst
Tufts Health Plan
01.2012 - 01.2017
- Company Overview: (fka) Network Health
- Performed a wide range of analytic projects of all complexities to address provider reimbursement
- Created, implemented and managed processes to ensure the proper and accurate payments of claims, in accordance to contracted rates, general billing guidelines, and specific company payment policies
- Wrote and implemented SQL program codes and queries which extracted appropriate data subsets from the production environment or internal data warehouses
- Worked with manager to identify and address expected and unforeseen data complexities
- Worked directly with Claims department in the resolution of suspect payments and created processes that resolved the root cause of the problem
- Provided business support on testing and quality assurance in Business Configuration unit
- Analyzed and documented system requirements and specifications using techniques as business modeling, logic / data flows, variable mapping, and data structures
- Made recommendations in the areas of performance standards and productivity improvements which were be implemented within the Business Configuration department
- Developed measurement tools to assist in current workflows and design of future workflows as new systems were implemented
- Worked with manager and IS Department to implement quality control processes for benefit, code sets, referral and auth rules, and contract set up processes
- (fka) Network Health
Senior Account Specialist – Provider Network Management
Tufts Health Plan
04.2006 - 01.2012
- Company Overview: (fka) Network Health
- Fulfilled supervisor responsibilities in the absence of the Provider Operations supervisor
- Trained, coached and mentored, in the capacity of a supervisor, a team of 4 account specialists
- Received, logged, and ensured timely response to inbound communication from providers and partners
- Generated provider and partner reports
- Provided presentations and orientations to educate providers and partners of our products
- Communicated policy or procedure changes to providers and partners
- Provided feedback to clinical affairs staff to design and implement quality improvement programs
- Coordinated and led high end projects, including provider conversions, service area expansions, and provider- or partner-driven voluntary enrollment campaigns
- Gathered, built, and maintained provider and partner account profiles with all appropriate contact information
- Assisted contracting department with contract preparation and tracking
- (fka) Network Health
Education
Major in Liberal Arts -
Bunker Hill Community College
12.1997
Major in Photography -
Massachusetts College of Arts
05.1997
Skills
- Proven Leadership Experience
- Proficient Vendor Relations
- Effective Client Relations Expertise
- Proficient in Administrative Services
- Detail-Oriented Approach
- Skilled in Meeting Critical Dates
- Efficient in Fast-Paced Environments
- Effective in Group Initiatives
Languages
Spanish
Native or Bilingual
Timeline
Specialty Pharmacy Liaison Supervisor, Patient Access Services
Alkermes, Inc.
05.2023 - 02.2025
Customer Service Supervisor, Patient Access Services
Alkermes, Inc.
04.2018 - 05.2023
Enrollment Supervisor
Tufts Health Plan
01.2017 - 03.2018
Provider Audit Analyst
Tufts Health Plan
01.2012 - 01.2017
Senior Account Specialist – Provider Network Management
Tufts Health Plan
04.2006 - 01.2012
Major in Photography -
Massachusetts College of Arts
Major in Liberal Arts -
Bunker Hill Community College
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