Patricia Macaspac
Glendale,CA
Summary
Accomplished Consultant drives organizational improvements through leveraging expertise in research and system enhancement. Well-versed in collaborating with employees and leaders to resolve control and procedural problems negatively affecting business operations. Dedicated to cost, process and resource optimization. Versatile [Type] Management Analyst with advanced knowledge of financial, business development and operational areas. Steps into new areas with adaptable approach. Practiced project manager and problem-solver with [Number] years of experience in [Industry].
Overview
18
18
years of professional experience
Work History
Payer Performance Analyst
OptumRx
10.2022 - Current
- Run and review a monthly analysis report for clients to ensure claims adjudicate correctly as per the contractual arrangement
- Present analysis and interpretation for operational and business review and planning
- Develop recommended business solutions through research and analysis of data and business process and implement when appropriate
- Review the completed monthly analysis and share to strategic account manager of the findings
- Review client’s contract pricing and create a template to add to the pricing database.
Specialty Audit Manager
OptumRx
07.2020 - 10.2022
- Auditing client benefit set-up and make sure that all products and benefits are processing correctly
- Run meeting with other department to provide information regarding audit results
- Create standard operating procedures for other team members to use when running audits
- Produce a week report of all the audit made from the previous week.
Business Drug List Analyst
OptumRx
10.2018 - 07.2020
- Maintain the creation and review of standard and custom drug list
- Creating internal notification to other department for new drug updates
- Run utilization report for any impacted member for any updates or changes in benefit coverage
- Auditing drug list and make sure that all products are processing correctly
- Run Drug List Committee calls scheduled weekly to review of any changes that could affect OptumRx and/or our client
- Submit request to Benefit Operation Management team of any drug benefit changes
- Present weekly to other department regarding any updates and changes that will take place for any existing or new drugs.
Client Relations Manager
OptumRx
03.2008 - 09.2018
- Lead and manage the implementation of a new client’s benefit
- Serves as the primary contact for escalated calls/e-mails from the client and assists with responding to service/operational issues providing prompt resolution for complete client satisfaction
- Interfaces with internal OptumRx resources (Customer Service, Implementation, Mail Service, Specialty, Clinical, Pharmacy Operations, Benefit Design, Eligibility or Client Management, Finance) for further investigation and resolution of client needs or requests
- Maintains expert knowledge of multi-channel process, to include plan benefits information, customer service skills, phone and computer databases and online support
- Responsible for working with account manager in implementing new and existing client specialty benefit
- Interfaces with identified external client liaisons or vendors, consistent with SOPs, for inquiries needing the assistance of client interaction
- Making sure that the contract follows state mandates for each client
- Create and produce a report for clients)
- Creating and maintaining client's specialty benefit information for the customer service advocate
- Providing utilization report as requested by the client or specialty operations team.
Pharmacy Technician/ Prior Authorization
Prescription Solutions
10.2006 - 03.2008
- Assist physicians or physician's personnel with pre-certification of medications
- Acting team lead in supervisor's absence
- Resolve escalated issues
- Trained Prior Authorization advocates in utilizing company software applications (RxExpress, GPS, Views, Score)
- Prepare monthly report for the supervisor on behalf of the teams' adherence and productivity
- Assist the supervisor to generate training manual designed for the customer advocates.
Education
Bachelor of Science: Criminal Justice -
Westwood College Of Technology
01.2008
Skills
- Multi-line phone talent
- MS Windows proficient
- Insurance policy review
- Strong conflict resolution skills
- Medical terminology knowledge
- Positive and friendly
- Adaptive learner
- Strong interpersonal skills
- Creative analytical person
Summary Of Qualification
Worked for PBM industry for 20 years. Determined and flexible in high-pressure situations. Successfully and aggressively complete task-oriented goals. Proficient at developing strong, long-term relationships with customers while meeting company objectives.
Timeline
Payer Performance Analyst
OptumRx
10.2022 - Current
Specialty Audit Manager
OptumRx
07.2020 - 10.2022
Business Drug List Analyst
OptumRx
10.2018 - 07.2020
Client Relations Manager
OptumRx
03.2008 - 09.2018
Pharmacy Technician/ Prior Authorization
Prescription Solutions
10.2006 - 03.2008
Bachelor of Science: Criminal Justice -
Westwood College Of Technology