Melissa Rafferty
St. Paul,MN
Summary
Experienced Account Director/PharmD with 14 years in the pharmacy benefit management (PBM) industry, specializing in Government Programs. Committed to enhancing business operations with a proven track record of integrating systems, aligning with business requirements, adhering to policies, and meeting regulatory standards. Exceptional organization and communication skills enable effective management and leadership of teams. Strong background in Operations and Account Management with extensive experience in interfacing and consulting on business processes, consistently driving outcomes based on sound overall business judgment.
Overview
24
24
years of professional experience
1
1
Certification
Work History
Sr Health Plan Account Director
Prime Therapeutics
2019.01 - Current
- Supports all account management activities for a large health plan including client contract, scorecards, and guarantees for Commercial and Medicare lines of business
- Develops and executes on joint strategic business opportunities through collaboration with internal partners and vendors
- Provides clinical, regulatory, and operational consultation on internal and external initiatives
- Provides clients with consultation on new programs, products and benefits
- Coordinates the implementation of new product adoptions, annual bid activities, and plan expansions
- Leads and mentors a team of 3 Health Plan Account Managers across 2 clients and 3 lines of business
- Provides exceptional client service and reaching the highest client satisfaction scores in Health Plan Markets
Sr Functional Business Owner
Prime Therapeutics
2015.12 - 2019.01
- Provided business ownership of system enhancements and product launches
- Managed workstream for new Medicare and Medicaid client implementations
- Ensured compliance with federal/state regulations and claim adjudication standards
- Provided cross-functional leadership in clinical, formulary, compliance, and IT workgroups
- Developed and implemented departmental policies and procedures
- Participated as Medicare SME in CMS audits
- Identified and executed on continuous improvement initiatives to streamline processes and improve quality of Formulary and Benefit Operations workstreams.
Sr Clinical Pharmacist
Prime Therapeutics
2010.12 - 2015.11
- Built and managed a knowledgeable and experienced team of Medicare and Medicaid Benefit Operations Pharmacists
- Served as escalation point for all client-related issues and requests unable to be supported by individual contributors
- Designed, built, and maintained Medicare and Medicaid benefit plans in accordance with all state and federal regulations
- Implemented adjudication system enhancements, policies, and procedures in support of client benefit design and state/federal regulations
- Collaborated with internal departments for cross-functional support of new product offerings, system functionality and client implementations.
Executive Staff Pharmacist
Target Corporation
2007.07 - 2010.12
IT & Management Consultant
Accenture
2000.08 - 2003.05
Education
Doctor of Pharmacy (PharmD) -
University of Minnesota College of Pharmacy
Minneapolis, MN06.2007
Bachelor of Arts - Mathematics
University of St. Thomas
St. Paul, MN05.2000
Skills
- PBM Industry
- Account and Contract Management
- Medicare / Medicaid Regulations
- Clinical Programs
- CMS Audit Support
- Benefit and Formulary Design
- NCPDP Telecommunication Standards
- Claim System Adjudication and Analysis
- Product and Service Promotion
- Project Management
- Medispan & First DataBank Drug Databases
- FDA Drug Databases
- Retail Pharmacy Practices
- Consulting
- Problem-Solving
- Teamwork and Collaboration
Certification
Pharmacist License, Minnesota, 2007, Present
Awards
- Prime Therapeutics President's Award 2020
- COVID-19 Cross-Functional Team 2021
- Contact Center Uplift Team 2019
Timeline
Sr Health Plan Account Director
Prime Therapeutics
2019.01 - Current
Sr Functional Business Owner
Prime Therapeutics
2015.12 - 2019.01
Sr Clinical Pharmacist
Prime Therapeutics
2010.12 - 2015.11
Executive Staff Pharmacist
Target Corporation
2007.07 - 2010.12
IT & Management Consultant
Accenture
2000.08 - 2003.05
Doctor of Pharmacy (PharmD) -
University of Minnesota College of Pharmacy
Bachelor of Arts - Mathematics
University of St. Thomas
Pharmacist License, Minnesota, 2007, Present
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