JENNY SAINT
MODA HEALTH
Portland,OR
1
Certification
2027
years of professional experience
Healthcare data and business analyst with 17 years across pharmacy and health plan operations, including extensive Medicare Part D experience. Specialized in investigating claims and eligibility issues, validating data across systems, and translating healthcare requirements into accurate reporting and system solutions. Lean Six Sigma Black Belt with hands-on SQL, advanced Excel/VBA, Tableau, UAT, data mapping, and root-cause analysis experience.
Work History
Manager, Pharmacy Operations
1 Year 3 Months- Lead Prior Authorization, Government Programs, and Quality & Compliance operations supporting 160,000+ prior authorizations annually, with six direct reports across operations, business analysis, program analysis, and quality/compliance and approximately 30 pharmacy technicians
- Reduced prior authorization turnaround time from 14 days to 3 days by analyzing workflow, realigning staffing, eliminating duplicate documentation, and redesigning pharmacist review responsibilities.
- Reduced overtime expense by more than 50% year over year through workload analysis, staffing controls, and closer monitoring of operational quality.
- Rebuilt and validated Medicare Part D CMS Program Audit universe, tracing data from ePA platform through reporting, testing field-level behavior, and developing data dictionary to enhance data integrity and reporting accuracy.
- Perform data-integrity and QA review of regulatory reports and files before external vendor delivery or mass loads, tracing unexpected results back to source data and reporting logic.
- Lead UAT for annual Medicare benefit implementations.
- Developed Tableau dashboards for authorization volume trends, year-end projections, and technician/pharmacist productivity analysis.
Pharmacy Business & Systems Analyst
4 Years- Validated configuration between Facets and the pharmacy claims platform, identifying discrepancies in group and plan setup, products, formularies, coverage codes, and benefit design before member impact.
- Investigated complex pharmacy claims, eligibility, benefit, and system issues using SQL and healthcare data to determine root cause and member impact.
- Traced rejected and paid claims across eligibility, Facets configuration, formulary mapping, coverage codes, and benefit tiers to determine why a claim behaved as it did and validate correct adjudication.
- Analyzed historical eligibility including effective dates, multiple eligibility segments, and retroactive terminations—to determine coverage at the time a claim adjudicated rather than relying only on current eligibility status.
- Supported client and annual benefit implementations from requirements through production readiness; developed test scenarios, mass-loaded test claims, and validated results against intended configuration.
- Partnered with Capital Rx to implement the Medicare Prescription Payment Plan (M3P), including requirements, configuration, testing, and operational readiness.
- Worked across pharmacy operations, technical teams, business stakeholders, and vendors to translate data findings and healthcare requirements into system corrections and operational solutions.
Program Coordinator, Care Coordination
1 Year- Analyzed healthcare reporting and operational data to identify trends and data-quality concerns, validated findings, and supported compliance and process-improvement initiatives.
- Coordinated cross-functional follow-up on care-management and operational issues, using reporting to clarify next steps and enhance process consistency.
- Tracked member and case information in electronic systems, maintaining accurate, timely records.
- Collaborated with care teams to resolve service issues and support coordinated patient workflows.
Manager, Pharmacy Operations
- Managed pharmacy operations and 19 pharmacy technicians, balancing daily workload and service expectations through effective staffing, productivity, quality, and workflow measures.
- Reviewed operational performance to identify workflow constraints and adjust staffing priorities, ensuring consistent pharmacy production and quality standards.
Assistant Care Manager, Care Coordination
1 Year- Analyzed KPIs, prepared ad hoc reporting, validated data accuracy, and reported weekly performance trends to identify issues and focus operational follow-up.
- Used performance data to surface exceptions and trends for care-coordination leadership, strengthening the connection between reporting and day-to-day operational decisions.
Pharmacy Automation Analyst
5 Years- Applied Lean Six Sigma, DMAIC/DMADV, root-cause analysis, and risk analysis to pharmacy automation systems and operational workflows.
- Analyzed workflow and system behavior, partnered with technical and pharmacy teams to troubleshoot issues, and supported automation changes from investigation through implementation.
- Developed process improvements, training, and change-management support to improve workflow reliability and adoption of pharmacy automation solutions.
Pharmacy Technician
4 Years- Prepared sterile IV medications to support neonatal and pediatric patient care in an inpatient hospital pharmacy.
Skills
Medicare Part D
Pharmacy Claims
Eligibility analysis
Facets
Eligibility analysis
Data validation
UAT
SQL
Advanced Excel/VBA
Tableau
CMS Reporting
Data mapping
Lean Six Sigma
Certification
Lean Six Sigma Black Belt (LSSBB), 2016, Certified Pharmacy Technician (CPHT), 2009
Timeline
Manager, Pharmacy Operations
MODA HEALTH
07.2025 - CurrentRead More
Pharmacy Business & Systems Analyst
PROVIDENCE HEALTH PLAN
01.2021 - 01.2025Read More
Program Coordinator, Care Coordination
OPTUM HEALTHCARE
01.2020 - 01.2021Read More
Assistant Care Manager, Care Coordination
DAVITA MEDICAL GROUP
01.2019 - 01.2020Read More
Pharmacy Automation Analyst
PRESBYTERIAN HEALTHCARE SERVICES
01.2014 - 01.2019Read More
Pharmacy Technician
UNIVERSITY OF NEW MEXICO HOSPITAL
01.2010 - 01.2014Read More
Manager, Pharmacy Operations
OMNICARE
2020 - 2020Read More