Michelle Guarino
Blue Springs,MO
Summary
Dependable and dedicated individual pursuing a position requiring a team member with initiative, enthusiasm and strong organizational and problem-solving skills. Having several years of experience in Pharmacy Benefit Management, Credentialing, Pharmacy Auditing and Customer Service.
Overview
24
24
years of professional experience
Work History
Pharmacy Network Analyst
SS&C Health
09.2023 - Current
- Work in close liaison with Pharmacy Chain Corporate Headquarters, PSAO’s (Pharmacy Services Administrative Organizations), and Independent Pharmacies
- Monitor State Licenses for all pharmacies that are contracted in SS&C Health Networks, ensuring they maintain an active state license
- If expired state licenses are identified, I create letters and send them out to the pharmacies on a weekly basis
- Share in monitoring the contracting inbox and the network pharmacy inbox, assisting Account Managers, Pharmacy Chains, PSAO’s and independent pharmacies with any of their needs
- Credential pharmacies that are joining SS&C Health Networks and perform ongoing credentialing for pharmacies currently enrolled
- Share in communicating between insurance companies and pharmacies in resolving all patient grievances that arise
- Work the monthly NCPDP file we receive from NCPDP, updating pharmacies that are joining a PSAO, moving to another PSAO or dropping from a PSAO
- Identify and implement department improvements and created new procedure documents for necessary changes and maintain the procedures making sure they are up to date with our processes
- Work to complete Customer Requests that are submitted by Prescription Plans that are contracted with us.
Enrollment Specialist
Pharmacy First
08.2022 - 09.2023
- Represented Independent Pharmacies as a Pharmacy Services Administrative Organization (PSAO)
- Work closely with the pharmacy to credential and enroll pharmacies into our services and perform yearly credentialing tasks
- Process contracts that come in when they are signed
- Update expired DEA, State Permit, Liability Insurance and PIC licenses for enrolled pharmacies through the National Council for Prescription Drug Programs (NCPDP) website.
Pharmacy Network Specialist III
SS&C Health
05.2020 - 08.2022
- Work in close liaison with Pharmacy Chain Corporate Headquarters, PSAO’s (Pharmacy Services Administrative Organizations), and Independent Pharmacies
- Monitor State Licenses for all pharmacies that are contracted in SS&C Health Networks, ensuring they maintain an active state license
- If expired state licenses are identified, I create letters and send them out to the pharmacies on a weekly basis
- Share in monitoring the contracting inbox and the network pharmacy inbox, assisting Account Managers, Pharmacy Chains, PSAO’s and independent pharmacies with any of their needs
- Credential pharmacies that are joining SS&C Health Networks and perform ongoing credentialing for pharmacies currently enrolled
- Share in communicating between insurance companies and pharmacies in resolving all patient grievances that arise
- Work the monthly NCPDP file we receive from NCPDP, updating pharmacies that are joining a PSAO, moving to another PSAO or dropping from a PSAO
- Identify and implement department improvements and created new procedure documents for necessary changes and maintain the procedures making sure they are up to date with our processes.
Investor Services Representative I
SS&C Technologies
02.2019 - 05.2020
- Provided internal and external customers with full-service solutions and comprehensive transfer agency and/or shareholder services
- Daily work included call center activity, transaction processing/data entry, customer correspondence, and quality assurance
- Maintained records for customers (e.g
- Shareholders, broker/dealers, third-party entities, institutions and client fund groups) and answer inquiries related to fund performance, account status and activity
- Processed financial and non-financial mutual fund and corporate security transactions, set up new accounts, perform research and resolve problems related to specific transactions through the utilization of various industry-related products/systems.
Self Checkout Host
Walmart Inc.
03.2019 - 06.2019
- Maintained area of responsibility in accordance with company policies and procedures
- Operated equipment and maintains functionality of self-checkout area, ensuring registers are operational, while assisting customers with questions and any transaction issues.
PSAO Representative
Pharm Assess Inc. - Community Independent Pharmacy Network (CIPN)
08.2017 - 07.2018
- Represented Independent Pharmacies as a Pharmacy Services Administrative Organization (PSAO)
- Contracted Independent Pharmacies for third party payer pharmacy contracts allowing the pharmacy to process prescriptions
- Credentialed newly enrolled pharmacies and performed yearly re-credentialing for pharmacies currently enrolled
- Performed monthly Office of Inspector General (OIG) and Government Services Administration (GSA) verification for enrolled pharmacies and their employees
- Updated expired DEA, State Permit, Liability Insurance and PIC licenses for enrolled pharmacies through the National Council for Prescription Drug Programs (NCPDP) website
- Assisted third party payers in required audits
- Operated as a liaison between insurance companies and pharmacies for resolving all issues that arise.
Senior Pharmacy Network Development Specialist
Argus Health Systems
11.2004 - 08.2017
- Worked in close liaison with Pharmacy Chain Corporate Headquarters, PSAO’s (Pharmacy Services Administrative Organizations), and Independent Pharmacies
- Created and implemented Pharmacy Networks for multiple insurance companies
- Executed Pharmacy Network Contracts
- Managed Long Term Care (LTC) Pharmacies transferring in and out of the Argus LTC Network
- Conducted Audit Assessments for the active Argus Pharmacy Networks
- Communicated between insurance companies and pharmacies in resolving all patient grievances that arise
- Assembled pharmacy bulletins regarding new insurance plans joining Argus Networks and for all process and formulary changes made to existing insurance plan customers
- Identified and implemented department improvements and created new procedure documents for necessary changes and trained anyone that was newly employed in the department.
Call Center Representative
Argus Health Systems
11.1999 - 11.2004
- Answered customer services calls for pharmacies that received claim rejections at Point of Sale (POS) when trying to process prescription insurance for members
- Assisted members through the member services phone line, specifically helping members with questions about their pharmacy benefits for certain plans.
Education
Philosophy
Longview Community College
Raytown High School
01.1996
Skills
- Microsoft Office Products
- RxNova Pharmacy System
- AWD Customer Request System
- Enlighten Tool
- Broadfax Builder
- PeopleSoft
- OBI Dashboard
- Network Configuration
- Documentation and Reporting
- Process Development
- Staff Training
Additional Information
Assisted in group planning for all activities with company functions., Floor leader in any type of emergencies that may happen within the company. In charge of marking all employees accounted for and reporting to company management.
Timeline
Pharmacy Network Analyst
SS&C Health
09.2023 - Current
Enrollment Specialist
Pharmacy First
08.2022 - 09.2023
Pharmacy Network Specialist III
SS&C Health
05.2020 - 08.2022
Self Checkout Host
Walmart Inc.
03.2019 - 06.2019
Investor Services Representative I
SS&C Technologies
02.2019 - 05.2020
PSAO Representative
Pharm Assess Inc. - Community Independent Pharmacy Network (CIPN)
08.2017 - 07.2018
Senior Pharmacy Network Development Specialist
Argus Health Systems
11.2004 - 08.2017
Call Center Representative
Argus Health Systems
11.1999 - 11.2004
Philosophy
Longview Community College
Raytown High School
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