James Patrick Heflin
Montgomery,Alabama
Summary
Experienced and proactive professional offering many years of progressive warehouse settings serving industry needs. Talented in overseeing cost control, loss prevention, and labor management initiatives to streamline and enhance operations. Decisive planner with good communication and problem-solving abilities.
Overview
22
22
years of professional experience
Work History
Manager Provider Relations
Optum Hospice Pharmacy Services
Montgomery, Al
09.2018 - 10.2024
- Led Pharmacy Relations team and guided Pharmacy Services supervisor
- Optimized teamwork to match client expectations alongside pharmacy constraints
- Held regular individual sessions to discuss and resolve project challenges
- Organized team training sessions regularly
- Fostered an open work culture to enhance efficiency
- Assisted with Client Services and At-Risk clients to identify pharmacy cost concerns and negotiate for lower pricing or define cost-effective pharmacy solutions to transition hospice business.
- Assessed and identified overall cost reductions for customers
- Led integration of new hospice clients, focusing on retail pharmacy solutions
- Assigned various client implementation projects to team members and reviewed results and progress to ensure smooth transition from a pharmacy perspective, billing notifications provided, services defined, fees negotiated and any billing NDCs provided to the pharmacies
- Point of contact for top pharmacy partners, directly handled pharmacy issues, reviewed market pricing to ensure pricing in line with market needs, assisted with additional growth opportunities with pharmacies to onboard additional hospice business
- Assisted with Business Development Department and prospective hospice client sales
- Reviewed markets to identify current pharmacy solutions
- Located and partnered with pharmacies in new or challenged markets to create cost effective retail pharmacy solutions for the Sales Team to provide to prospective hospice clients
- Assisted in RFP process
- Discussed appropriate pricing models to incorporate into cost analysis
- Reviewed pharmacy pricing to apply for cost analysis
- Reviewed completed cost analysis prior to client presentation to ensure accuracy
- Mail order Pharmacy
- Worked closely with Mail Order vendor in growth strategies to present to clients benefits of mail order solutions
- Identify client and market needs and provide analysis or potential hospice volume, cost analysis to confirm cost impact for transition to mail
- Assisted in mail override network build and incorporation into overall rxclaim pharmacy network
- Worked with outside departments on larger projects or resolving issues within rxclaim
- Genoa Healthcare Hospice market roll out
- National Infusion Network solution
- Reviewed various issues and questions regarding claim processing within rxclaim (Network/formulary)
- Collaborated with OptumRx pricing team to build and maintain client specific pricing to help manage client specific pricing to an overall Generic effective rate in line with contracted SLAs
- Managed quarterly market review rollout for internal team and client services
- Tracked pharmacies and quarterly claim volume defining additional pharmacy services, pricing and long-term pharmacy details to assist outside departments with identifying possible pharmacy solutions for clients based on geographic locations, City, County and State
- Worked on a national pharmacy specific detail listing to better track specific pharmacy service details and pricing to eventually incorporate into an internal database allowing different departments easier access to pharmacy details based on geographic locations
Supervisor Pharmacy Relations
Optum Hospice Pharmacy Services
Montgomery, AL
11.2017 - 09.2018
- Supervised small team to handle pharmacy challenges efficiently
- Facilitated understanding of operational functions among newly hired employees.
- Supported client services by conducting high-level pharmacy reviews to identify cost-saving measures
- Revised pharmaceutical contracts to minimize client's financial burden
- Facilitated organizational discussions on pharmacy pricing and market topics
- Conducted weekly meetings with team members to discuss upcoming tasks and project deadlines.
- Resolved client and pharmacy complaints and issues promptly, ensuring customer satisfaction and loyalty.
Pharmacy Relations Coordinator
Optum Hospice Pharmacy Services
Montgomery, AL
05.2013 - 11.2017
- Addressed and resolved various pharmacy concerns daily.
- Resolved pharmacy pricing discrepancies for one-time medications.
- Negotiated pharmacy contracts and service fees effectively, including cost analysis to identify potential client cost impact.
- Conducted market reviews to identify suitable pharmacy solutions to meet diverse hospice needs.
- Secured contracts with Infusion Pharmacies.
- Support new client onboarding by with pharmacy outreach to notify of PBM change, review current services and fees, and discuss any pharmacy pricing questions.
Pharmacy Research and Development Representative
Optum Hospice Pharmacy Services
Montgomery, AL
03.2011 - 05.2013
- Update facility pharmacy information from daily admit and MPA reports.
- Worked assigned KACE issues in a timely fashion.
- Manually reprocessed claims billed outside of the billing window upon hospice client authorization.
- Continue serving as the primary pharmacy service representative for assigned pharmacies.
Pharmacy Service Representative
Optum Hospice Pharmacy Services
Montgomery, AL
04.2010 - 03.2011
- Handled calls, faxes, and emails to resolve issues related to medication rejections faced by pharmacies.
- Worked faxes from hospices to admit, discharge, or update patient profiles.
- Managed multiple tasks with a strong emphasis on accuracy and time.
- Served as the primary pharmacy service representative for multiple pharmacies/hospice clients to resolve billing, processing issues, and rejections.
Radiology File Clerk/Office Assistant
Santa Rosa Medical Center
Milton, Fl
05.2002 - 05.2009
- Managed communications with other facility departments.
- Assisted patients with questions and requests.
- Maintained patient records and films.
- Developed strong professional relationships with radiologists and other physicians.
- Assisted in organizing patient records for storage or retrieval purposes.
Education
Bachelor of Science - Health Administration
GPA: 3.11
03.2008
Political Science, History
01/2000
01.2000
Skills
- Key Performance Indicators
- Time Management
- Verbal and written communication
- Cross-functional team management
- Complex Problem-Solving
- Key Performance Indicators
- Time Management
- Verbal and written communication
- Cross-functional team management
- Complex Problem-Solving
References
References available upon request.
References
References available upon request.
Timeline
Manager Provider Relations
Optum Hospice Pharmacy Services
09.2018 - 10.2024
Supervisor Pharmacy Relations
Optum Hospice Pharmacy Services
11.2017 - 09.2018
Pharmacy Relations Coordinator
Optum Hospice Pharmacy Services
05.2013 - 11.2017
Pharmacy Research and Development Representative
Optum Hospice Pharmacy Services
03.2011 - 05.2013
Pharmacy Service Representative
Optum Hospice Pharmacy Services
04.2010 - 03.2011
Radiology File Clerk/Office Assistant
Santa Rosa Medical Center
05.2002 - 05.2009
Bachelor of Science - Health Administration
GPA: 3.11
Political Science, History
01/2000
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