MELISSA JANSEN
Quincy,IL
Summary
Service-oriented professional with over 12 1/2 years experience in pharmacy and managed care. Results oriented with a talent for problem solving, customer service, researching, and reporting. Recognized for benefit coding and achieving tasks within timely manner. Expert in several coding applications including BlueSTAR, Benefit Edit Tool, Benefit Management Toolbox, RxClaims AS400, RX products ( FLEXACCESS). Exceptional interpersonal and relationship skills to foster trust and respect within the workplace.
Experienced leader with strong background in guiding teams, managing complex projects, and achieving strategic objectives. Excels in developing efficient processes, ensuring high standards, and aligning efforts with organizational goals. Known for collaborative approach and commitment to excellence.
Overview
2027
2027
years of professional experience
Work History
Pharmacy Management Consultant
HCSC - Blue Cross Blue Shield of Illinois
Quincy, IL
2024 - 03.2026
- Led cross-functional teams to streamline operational processes and improve product delivery efficiency.
- Developed strong relationships with key stakeholders at all organizational levels, fostering collaboration across departments.
- Developed strategic frameworks to enhance client engagement and satisfaction across multiple initiatives.
- Implemented performance metrics to evaluate project outcomes, driving continuous improvement in service delivery standards.
- Reviewed internal systems and organized training plans to address areas in need of improvement
- Handling over several hundred accounts on daily basis for products
Pharmacy Implementer Consultant
Health Care Service Corporation (HCSC)
Quincy, IL
2021 - 2024
- Assist in implementing new and renewing groups along with managing post implementation discrepancies and questions.
- Work directly with the Sales and Marketing, Group Experience Team, clients and brokers, Pharmacy Coders/Benefit Installation, Product Management, and with Prime Therapeutics, our Pharmacy Benefit Manager (PBM), to help ensure proper implementation of new and renewing custom IL, MT, and NM groups.
- Subject matter expert (SME) for pharmacy benefit implementation.
- Advise and assist on product availability and implementation.
- Support in identifying and correcting member issues.
- Daily maintenance of group and benefit questions through our shared mailbox.
- Manage group excel workbooks to ensure action items are completed within timeframe.
- Work with Prime Strategic Pharmacy Consultants and Managers to interpret pharmacy benefits and products to clients
- Review and compare benefits on the pharmacy paperwork to the Benefit Edit Tool through Prime Therapeutics.
- Implement the new ADM model for Trustmark groups (IL template).
- Assist in modifying and testing the new Ordure Capture process to improve pharmacy paperwork
- Train other pharmacy implementation consultants on Fully Insured and ASO accounts
- Manage and oversee pharmacy CBSR (Custom Benefit & Services Review) process. Review and research CBSR’s to approve or deny.
- Lead projects with CSS, pharmacy coding team, and pharmacy implementers to improve the CBSR process.
- Handling custom benefits for companies
Pharmacy Benefit Coder
Health Care Service Corporation (HCSC)
Quincy, IL
01.2017 - 01.2021
- Coded pharmacy benefits for large groups in several different states (IL, TX, OK, & NM).
- Worked directly with medical and pharmacy coders, implementers, account executives, client service specialists, account specialists, and Prime Therapeutics to correctly code each case and state.
- Created benefits using the Benefit Edit Tool through Prime Therapeutics.
- Maintained and updated recycle files for commercial and retail plans in Prime AS/400.
- Peer Reviewed all IL Rx coders work. Mentored newer coders and helped train, advise, and peer review their cases to check for errors.
- Part of the Forms Governance (FG) team. Reviewed pharmacy paperwork for large group business to assist with form clarity, consistency, and help support non-benefit form updates for the IL state.
- Manage pharmacy escalation mailbox for escalations from our partners Sales and Marketing, Prime Therapeutics, and Pharmacy Customer Service Coordinators.
Pharmacy Customer Advocate II
Health Care Service Corporation (HCSC)
Quincy, IL
01.2013 - 01.2017
- Provided telephone support while troubleshooting, investigating, resolving billing problems, managed prior authorization requests and appeals, and resolving coding issues with member claims and benefits.
- Trained new employees on all computer applications and supported them while on live calls.
- Generated new employee progress reports for supervisor review.
- Assisted line support for the pharmacy department.
- Selected to be part of the inventory team.
- Worked on escalation calls from members transferred from supervisors and customer advocate specialist.
- Accenture: Was selected to meet with them on Bluesource improvements for the company.
- Attended interview workshops within our Quincy BCBS office.
- Attended the Strategic Academy for Leadership Training & Performance Enhancement Program (SALT & PEP) and graduated from the Quincy office.
- Received medical training for Texas 204 group. Assisted with member phone calls, medical claims, and member billing issues.
- Completed Blue Value Adviser (BVA) training for all books of business, including Prior Authorization and cost estimates for member's procedures.
Education
Associate of Science - Nursing License Practical Nursing
John Wood Community College
Quincy, IL01-2021
Pharmacy Technician Certification - Pharmacy
Spoon River College
Macomb, IL01-2021
Skills
- Problem-solving
- Critical Thinking
- Research & Analytics
- Time Management
- Benefit Coding
- Customer & Client Management
- Customer Service
- Self-Starter
- Microsoft Office Applications
- Operations and Product management
Timeline
Pharmacy Benefit Coder
Health Care Service Corporation (HCSC)
01.2017 - 01.2021
Pharmacy Customer Advocate II
Health Care Service Corporation (HCSC)
01.2013 - 01.2017
Pharmacy Management Consultant
HCSC - Blue Cross Blue Shield of Illinois
2024 - 03.2026
Pharmacy Implementer Consultant
Health Care Service Corporation (HCSC)
2021 - 2024
Associate of Science - Nursing License Practical Nursing
John Wood Community College
Pharmacy Technician Certification - Pharmacy
Spoon River College