Jennifer Lambert

• Delivery of rapid quality and process improvement information to the technicians on the team, preparing material for and delivering team meetings, and ultimately serving as a subject matter expert for the team, including programs such as TruCare, Compass, Amisys, and Portico.
• Track and triage coverage determination requests submitted from providers and determine if a pharmacist review is required.
• Approve coverage determination requests based on defined criteria.
• Contact providers for additional information to facilitate coverage determination reviews.
• Notify physicians, providers and members of coverage determination request decisions.

• Accurately entering data and triaging coverage determination requests for 35 lines of business, while maintaining compliance.
• Sending notifications to physicians, providers, and members of coverage determination request decisions.
• Meeting and adhering to all departmental regulatory and operational productivity and quality processes and procedures.
• Teaching and training peers on departmental regulatory and operational processes and procedures.
• Cross-trained on all Lead Technician responsibilities and assisted with them daily as well as for coverage purposes.

• Pricing and filling prescriptions while managing inventory and proper storage and security conditions of drugs.
• Processing insurance claims and initiating prior authorizations.
• Effective communication with both patients and prescribers.
• Maintaining accurate patient profiles and proper protection and/or destruction of patient protected health information.

• Theft and fraud mitigation through investigations, internal and external theft management, and facility security.
• Process improvement through operations audits, inventory audits, financial research, and compliance.
• People investment through execution of the Total Safety Program, operations management, and event management.
• Responsible for the safety and compliance of 300 associates/managers.

• Processing vendor and distribution center invoices and resolving billing inaccuracies, capturing potential lost profit.
• Maintaining store inventory levels and item files.
• Maintaining financial and environmental compliance record retention systems.

• Pricing and filling prescriptions while managing inventory and proper storage and security conditions of drugs.
• Processing insurance claims and initiating prior authorizations.
• Effective communication with both patients and prescribers.
• Maintaining accurate patient profiles and proper protection and/or destruction of patient protected health information.