Katrina Munoz
San Antonio,TX
Summary
Healthcare professional seeking an opportunity within a new environment to further develop skills, take on new challenges, and pursue continued professional growth.
Overview
20
20
years of professional experience
Work History
Benefit Relationship Manager (Employer)
CVS Health
San Antonio, TX
10.2023 - Current
- Collaborated with clients and account teams to define and document plan requirements
- Managed monthly maintenance cases for clients and ensured accuracy of custom setups
- Created project cases to test and validate client-requested custom configurations.
- Created and updated plans in the MyPBM automation system
- Managed new business implementations for clients who were joining CVS Health.
- Experienced in utilizing FMS (Formulary Management System) program to complete coding updates for some clients with custom list setups.
- Handled research cases initiated by Account Management, which consisted of reviewing claims or benefit setups.
- Attended client meetings and provided benefit updates on open coding cases related to plan changes.
Pharmacy Care Rep
HEB Central Fill
San Antonio, TX
08.2023 - 10.2023
- Packaged medications for shipping.
- Kept pharmacy counter and related areas clean, neat and organized.
- Maintained printers, labels and bagging on machines and changed them out when needed.
- Assisted Pharmacy Technicians when needed for uncapping medication bottles for specific stocking areas.
- Ability to lift up to 30lbs in boxes to reload stations
Benefit Relationship Manager (HealthPlans)
CVS Health
San Antonio, TX
10.2022 - 08.2023
- Documenting requirements with clients, Implementation and Account Managers
- Consulting with clients on proposed solutions to meet objectives/ goals
- Research, analyze impacts of requirements or errors and provide direction on adjudication setups and solutions to configuration and quality for mitigation
- Experienced in all lines of business (Exchange, Comm, Medicaid and Med D)
Benefits Setup Rep
CVS Health
San Antonio, TX
03.2018 - 10.2022
- Responsible for analyzing client requests and performing the necessary benefits coding.
- Responsible for validating coding accuracy utilizing various tools
- Responsible for meeting TCDs/ turnaround times.
- Experience with AS400/ RxClaim for 6+ years.
- Work with Benefit Relationship Managers to determine client intent.
- Started in benefits coding as a rep I in 2018 and was promoted over time. Became a rep III early of 2022
Client Support
CVS Health
San Antonio, TX
08.2013 - 02.2018
- Responsible for complaints, suggestions & comments in queue
- Received & responded to client issues in a timely manner via email, fax & phone
- Responsible for timely follow up on requests to ensure resolution
- Provided plan benefit overrides in RX Claim at client’s request
- Represented Caremark at client benefit fairs as needed
- Provide feedback to Customer Care Management on servicing incidents & developing service trends
- Accessed Behavioral Analytics to have call pulls & provided feedback to Management
- Assist with reporting data daily, for email & call volume
- Responsible for working Care AM Outreach cases within Salesforce & provide resolution to member for commercial clients
Accounts Receivable
CVS / Caremark Pharmacy
San Antonio, TX
11.2008 - 08.2013
- Patient contact regarding prescriptions and educating in plan benefits regarding GAP, MAB and deductibles in a high volume Inbound and Outbound call center
- Research and analyze prescription orders in order status queued through Resolution Manager Tasks to maintain customer satisfaction
- Call members to obtain/update method of payment for prescription orders in process
- Skilled in shipping fulfillment to assist with redirecting prescription orders to correct addresses and avoid reship cost
- Trained new hires for accounts receivable in workflow process to resolve various billing issues for prescription orders
- Skilled for participant services in reaching out to members to obtain pertinent information needed to fill orders in a timely manner
- Selected to perform pilot projects for accounts receivable on new workflow process
Accordant Care Activation Specialist
CVS / Caremark Pharmacy
San Antonio, TX
04.2006 - 11.2008
- Made outbound calls to explain the health management benefits program provided by insurance companies for patients with health conditions and diseases
- Enrolled patients in the health management program according to established guidelines
- Maintained integrity of patient demographic and health information by researching and verifying data
- Effectively communicated with day and evening team leaders and other members of the team
- Responded to internal and external customer requests for information and assistance as well as transferred them to the appropriate party in a timely manner
- Maintained an acceptable amount of weekly activations as deemed appropriate by management
Education
DIPLOMA -
Southside high school
2004
UNIVERSITY OF PHOENIX, Some College
Skills
- Attention to detail and great organizational skills
- HIPAA Compliance
- Health Insurance plan knowledge
- Inbound/ Outbound phone etiquette
- Knowledge in Microsoft office (Word, Excel, etc) & Teams
- Effective in working in a team environment, as well as working independently
- Strong communication skills
- Completed Senn-Delaney Leadership Training
- Experience in SalesForce
- Knowledge in RxClaim
- Typing speed of 45 WPM
- Knowledge of MyPBM Automation System
- Knowledge of FMS (Formulary Management System)
- Resolving Complaints
Timeline
Benefit Relationship Manager (Employer)
CVS Health
10.2023 - Current
Pharmacy Care Rep
HEB Central Fill
08.2023 - 10.2023
Benefit Relationship Manager (HealthPlans)
CVS Health
10.2022 - 08.2023
Benefits Setup Rep
CVS Health
03.2018 - 10.2022
Client Support
CVS Health
08.2013 - 02.2018
Accounts Receivable
CVS / Caremark Pharmacy
11.2008 - 08.2013
Accordant Care Activation Specialist
CVS / Caremark Pharmacy
04.2006 - 11.2008
DIPLOMA -
Southside high school
UNIVERSITY OF PHOENIX, Some College