Summary
Overview
Work History
Education
Skills
Timeline
Generic

LISBETH CALZADILLA PAEZ

Youngsville,USA

Summary

Passionate and results-driven Interim Program Manager with a strong commitment to team development, process optimization, and operational excellence. At Mercalis, I have led initiatives that enhanced case completion rates, optimized workload distribution, and empowered teams. I take pride in mentoring and coaching, helping individuals grow while improving performance. Highly detail-oriented, with a strong ability to validate and confirm data accuracy, while managing performance and fostering cross-team collaboration. I strive to create efficient workflows and impactful solutions. As a bilingual leader (English and Spanish), I ensure seamless communication and coordination across diverse teams.

Overview

8
8
years of professional experience

Work History

Interim Program Manager

Mercalis
Morrisville, USA
10.2024 - Current
  • Overseeing the LEAP project, managing workflow, tracking applications, and troubleshooting errors to ensure timely enrollment processing.
  • Managed a team of three supervisors with direct reports, providing guidance, and ensuring performance expectations are met.
  • Conduct performance reviews for supervisors, setting development goals, and tracking progress to ensure continuous improvement.
  • Participated in meetings with the Puerto Rico team, SPLs, and leadership, leveraging bilingual proficiency to address concerns and enhance the enrollment process.
  • Ran and loaded work-in-progress reports, monitored and allocated workloads efficiently, and collaborated with the PM team to analyze and address the increase in active, in-progress cases.
  • Identified key factors such as low agent productivity and improper allocation, implementing solutions that improved case completion rates, and contributed to a reduction in reported work-in-progress cases.
  • Developed and maintained a Reporting/Workload Overview Job Aid to streamline data tracking and case management.
  • Oversaw the implementation of verbal and written warnings, as well as Performance Improvement Plans (PIPs), by supervisors, ensuring compliance with policies and proper review by HR and the internal compliance team before issuance.
  • Worked with supervisors and APMs to identify performance trends, develop solutions, and improve team efficiency.
  • Led select sessions in client and IBM meetings, ensuring process alignment, system improvements, and issue resolution.
  • Led call calibration meetings as part of a scheduled rotation to maintain quality assurance and compliance.
  • Collaborated with the training team to review and enhance training materials before rollout, ensuring effective program implementation and consistency.
  • Monitored service levels for inbound and outbound calls, ensuring agents adhere to customer service standards.
  • Collaborated with IBM to escalate and resolve system issues, improving system functionality, and team efficiency.

Associate Program Manager

Mercalis
Morrisville, USA
08.2024 - 10.2024
  • Conducted performance reviews for SPLs, establishing development goals, and monitoring progress to support professional growth.
  • Oversaw daily work reports, pulling data from Salesforce, and updating Work in Progress spreadsheets.
  • Optimized resource allocation to ensure balanced workloads, and efficient case resolution.
  • Conducted QA/QC and client calibration reviews, providing coaching to improve agent performance.
  • Led SPL team meetings, ensuring alignment on program updates and process consistency.
  • Implemented a team development plan, resulting in multiple successful promotions into leadership roles.
  • Strengthened coaching and mentoring skills, fostering career growth among team members.

Specialty Pharmacy Liaison (SPL) Supervisor

Mercalis
Morrisville, USA
12.2023 - 09.2024
  • Conducted performance reviews for SPLs, identifying strengths and opportunities for development to enhance team effectiveness.
  • Supervised a team of 8 to 9 agents, ensuring quality and productivity standards were met.
  • Held biweekly one-on-one coaching sessions, offering coaching, and performance feedback.
  • Identified agents' career interests, leading to three successful promotions within the company.
  • Designed and implemented a performance improvement plan, including mock interviews and resume-building workshops.
  • Organized monthly team meetings, assigning leadership roles to promote skill-building, and engagement.
  • Led the SPL Appeals Process initiative, managing over 300 appeals, and implementing process improvements.
  • Collaborated with SPL supervisors on training, attendance tracking, and performance management.
  • Provided specialty pharmacy support via Webex chat, troubleshooting RX cases, and liaising with pharmacy teams.
  • Oversaw critical reports such as "Failed to be Picked" and "NDC Code and Brand-named Mismatch," ensuring accuracy and timely resolution.

Specialty Pharmacy Liaison (JPAP)

Mercalis
Morrisville, USA
02.2023 - 12.2023
  • Process refill requests from patients and health care providers via telephone, fax, or electronic means.
  • Monitor patient documents for potential adverse reactions, product quality complaints, and report the event if necessary.
  • Make outbound calls to patients and health care providers to confirm the next fill date prior to triaging to the pharmacy, and answer inquiries regarding prescription status.
  • Complete outreach to sites, and advise when the patient is out of refills.
  • Informed of the proper documentation needed to continue refills.
  • Assist with keeping track of refill requests made by Care Coordinators, and enter data into the spreadsheet.
  • Assisted with one-on-one SPL training and shadowing.
  • Complete all tasks and cases within the SLA time frame.

Program Supervisor (Welcome Season)

TrialCard
Morrisville, USA
10.2022 - 02.2023
  • Coordinated training materials for new hires.
  • Evaluated the assignment of agents throughout training to maintain the quality and effectiveness of resources provided.
  • Coordinated with other supervisors, combining group efforts to achieve overall program goals.
  • Provided direct service and support by handling multiple agents' questions in a fast-paced group chat.
  • Assigned and monitored BI cases, and provided agents with feedback.
  • Set clear expectations for achieving each target by sending weekly email reminders.
  • Assisted in pulling and reviewing reports on employees' attendance and productivity to evaluate performance.

Specialty Pharmacy Liaison

TrialCard
Morrisville, USA
08.2019 - 10.2022
  • Responsible for keeping track of the state-assigned queue.
  • Completed RX cases by triaging (PEF) to specialty pharmacies for all immunology drugs.
  • I reached out to the Specialty Pharmacy to confirm that the prescriptions were received and that the medication was shipped to the patients.
  • Assisted pharmacy technicians in troubleshooting rejected claims by providing correct savings card information or rejection codes from project sheets.
  • Gathered pharmacy data, such as medication shipment status, in order to update RX cases in Salesforce.
  • Completed all assigned tasks and cases within SLA guidelines.
  • Attended leadership conferences related to program topics and goals.

Care Coordinator/ Reimbursement Specialist

TrialCard
Morrisville, USA
04.2019 - 08.2019
  • Conducted a benefit investigation to verify insurance coverage, medical billing, and the reimbursement process.
  • Conducted prior authorization and appeal follow-up with the payer, tracked and documented case status, and provided follow-up to the provider and patient regarding the decision.
  • Provided assistance to physician office staff and patients to complete and submit all necessary prior authorization and formulary exception forms.
  • Served as an advocate for the patient regarding eligibility requirements, program enrollment, reimbursement processes, affordability/copay support, and foundation assistance.
  • Established relationships, developed trust, and maintained rapport with patients, health care providers, PAS representatives, and payers.
  • Served as the main point of contact for HCPs, patients, and PAS representatives.
  • Explained the benefits offered by all payer types, including private, commercial, and government.
  • Conducted follow-up calls to health care providers and patients to deliver benefits obtained.
  • Analyzed the patient's explanation of benefits (EOBs) to submit the patient rebate request.

Support Care Coordinator Team Lead

TrialCard
Morrisville, USA
01.2019 - 04.2019
  • Performed side-jack checks, listening in on calls, and provided agents with coaching to improve performance.
  • Ensured that the team achieved daily goals in production and service levels.
  • Provided trending data and ideas among leadership to increase the productivity of the team.
  • Mentored and guided agents, ensuring all were trained in system and product knowledge.
  • Handled complex, escalated calls that required special research and follow-up calls in a timely manner.
  • Handled calls when the phone queue was full in order to meet daily goals.
  • Coordinated and led refresher trainings.
  • Performed daily floor support.

Support Care Coordinator

TrialCard
Morrisville, USA
08.2018 - 01.2019
  • Handled inbound calls to find solutions for patients who are having financial hardships.
  • Trained new employees on how to handle calls and adhere to company expectations.
  • Managed time to always be available to service patients without hold time.
  • Completed trouble tickets and adverse events for patients to ensure company standards.

Intake and Triage Coordinator

TrialCard
Morrisville, USA
04.2018 - 07.2018
  • Input all patient information received into QuickPath in a timely manner.
  • Review and ensure that all incoming forms are complete.
  • Follow up with patients and physicians as appropriate to collect and capture missing or incomplete information.
  • Create new patient profiles, or accurately associate referrals to existing profiles.
  • Ensure all necessary information is received and provided for prior authorizations.
  • Answer and transfer inbound calls to assigned case managers, if necessary.
  • Input all patient information received on Formstack (online form submission), and create accounts for the case manager to follow up.

Patient Experience Specialist

TrialCard
Morrisville, USA
12.2017 - 04.2018
  • Resolve problems by clarifying issues, researching and exploring answers, and alternative solutions, implementing solutions, and escalating unresolved problems.
  • Answer any inquiries and desired information by clarifying, researching, locating, and providing information.
  • Identify and correctly report adverse events, high-dose alerts, medical inquiries, and product complaints.
  • Assist the pharmacist in troubleshooting claims to receive a discount from the copay card.

Outbound Patient Experience Specialist

TrialCard
Morrisville, USA
03.2017 - 12.2017
  • Made outbound calls to educate and clarify program updates.
  • Collected the needed information from the patient to update accounts.
  • Assisted customers with program re-enrollment.
  • Contact the pharmacy if desired by the patient to provide copay card assistance.

Education

High School Diploma - Law

Bronx Community College
The Bronx, NY, USA
06.2011

High School Diploma -

Washington Irving HS
New York, NY, USA
08.2008

Skills

  • Program Management
  • Team Leadership and Development
  • Performance Reviews and Coaching
  • Process Improvement and Optimization
  • Training and Quality Assurance
  • Data Analysis and Reporting
  • Cross-team collaboration

Timeline

Interim Program Manager

Mercalis
10.2024 - Current

Associate Program Manager

Mercalis
08.2024 - 10.2024

Specialty Pharmacy Liaison (SPL) Supervisor

Mercalis
12.2023 - 09.2024

Specialty Pharmacy Liaison (JPAP)

Mercalis
02.2023 - 12.2023

Program Supervisor (Welcome Season)

TrialCard
10.2022 - 02.2023

Specialty Pharmacy Liaison

TrialCard
08.2019 - 10.2022

Care Coordinator/ Reimbursement Specialist

TrialCard
04.2019 - 08.2019

Support Care Coordinator Team Lead

TrialCard
01.2019 - 04.2019

Support Care Coordinator

TrialCard
08.2018 - 01.2019

Intake and Triage Coordinator

TrialCard
04.2018 - 07.2018

Patient Experience Specialist

TrialCard
12.2017 - 04.2018

Outbound Patient Experience Specialist

TrialCard
03.2017 - 12.2017

High School Diploma - Law

Bronx Community College

High School Diploma -

Washington Irving HS

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LISBETH CALZADILLA PAEZ