Laura Roderick
Cleveland,TN
Summary
Strong mind set to manage projects and situations in a timely manner and with positive results. High comprehension of pharmacy business procedures with a strong background in detailed clerical work, professionalism, and communication skills.
Overview
8
8
years of professional experience
2
2
Certifications
Work History
Client Service Executive
Epiphany Rx
2 2024 - Current
- Delegate, support and provide guidance to colleagues in Senior CSC and CSC roles
- Support/back up the Senior CSE’s as needed
- Pull data from 3-D and other tools to deliver facts-based presentations (including Strategic Business Plans, VALUE Summaries, and Performance Standard reports) to clients
- Work closely with Clinical Account Executive on data, strategy, and the Epiphany Rx team approach to all meetings
- Facilitate resolution of escalated member/Client issues requests
- Manage Client and Advisor relationships and business activities
- Identify and present Client opportunities to improve costs, services and health
- Contract maintenance and performance
- Client retention
- Lead or support internal department and corporate projects
- Travel to Client sites
- Provide mentoring to the coordinator levels.
Account Service Manager
Elevance Health (Carelon Rx)
06.2022 - 02.2024
- Responsible for providing advanced customer service representation and strategic planning for large accounts
- Organize cross-functional teams, drive projects & ongoing deliverables and to be able to track & report on the status of the aforementioned
- Directs and manages the administration of contractual requirements and obligations
- Leads cross-functional teams to design and implement new processes and regulatory requirements
- Experience creating business cases and project charters for new projects
- Experience in assisting in conducting analysis including data analysis and leading root cause analysis reviews
- Oversees and monitors operations KPIs, SLAs and performance guarantees for accounts and follows up as needed, including additional analysis to ID root cause and follow up to remediate.
CLINICAL PHARMACY SPECIALIST
BLUE CROSS BLUE SHIELD OF TENNESSEE
12.2018 - 06.2022
- Triage requests such as faxes and phone calls from members and providers to ensure requests are handled in a timely manner
- Build and manage cases for prior authorization, exceptions, and appeals
- Prepares and facilitates Level 2 appeals with Maximus Federal Services
- Communicates with doctors’ offices and hospitals to gather case clinical information
- Manages RX411 inquiries and performs system edits for claims
- Process Direct Member Reimbursements and oversight reports
- Prepares multiple weekly reports for audit and tracking purposes
- Knowledge of Medicare and CMS guidelines
- Participates in Quarterly Departmental Audits.
CERTIFIED PHARMACY TECHNICIAN (IV AND SURGERY)
CHI MEMORIAL HOSPITAL
08.2017 - 02.2019
- Prepared, filled, and distributed unit dose medications
- Triaged pharmacy phone calls for Pharmacist
- Performed clerical functions such as answering phone, maintaining files, charging/credits daily for billing
- Resupplied medications to maintain levels of stock to nursing floors
- Prepared and delivered IVs
- Maintained a professional and positive attitude with all hospital personnel
- Proficient in Meditech Software to maintain/manage patient accounts
- Maintained surgery pharmacy stock and delivered to Surgical Units/OR’s
- Responsible for updating anesthesia records in system for Pharmacy Dept.
CERTIFIED PHARMACY TECHNICIAN
WALMART NEIGHBORHOOD MARKET PHARMACY
03.2016 - 08.2017
- Filled, bagged, and sold prescriptions to patients
- Adjusted insurance claims with numerous insurance providers
- Responsible for maintenance of prior authorizations for patients
- Referred inquiries to Pharmacists
- Performed clerical work such as calling doctors’ offices and local hospitals
- Conducted compliance telephone calls to patients regarding refills for maintenance.
Education
Bachelor of Arts - Healthcare Adminstration
Liberty University
Lynchburg, VA 05.2001 -
Skills
Strong Oral and Written Communication skills
Strong Analytic Skills
Microsoft Skills
Time management skills
Multitasking Abilities
Certification
CERTIFIED PHARMACY TECHNICIAN (National Healthcare Association-Certified since 2016)
Timeline
Account Service Manager
Elevance Health (Carelon Rx)
06.2022 - 02.2024
CLINICAL PHARMACY SPECIALIST
BLUE CROSS BLUE SHIELD OF TENNESSEE
12.2018 - 06.2022
CERTIFIED PHARMACY TECHNICIAN (IV AND SURGERY)
CHI MEMORIAL HOSPITAL
08.2017 - 02.2019
CERTIFIED PHARMACY TECHNICIAN
WALMART NEIGHBORHOOD MARKET PHARMACY
03.2016 - 08.2017
Bachelor of Arts - Healthcare Adminstration
Liberty University
05.2001 -
Client Service Executive
Epiphany Rx
2 2024 - Current
CERTIFIED PHARMACY TECHNICIAN (National Healthcare Association-Certified since 2016)
SIX SIGMA- Yellow Belt Certification (Project Improvement Cert.)
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