Sharon Perez
Des Plaines,United States
Summary
Dedicated healthcare professional with history of meeting company goals utilizing consistent and organized practices. Skilled in working under pressure and adapting to new situations and challenges to best enhance the organizational brand.
Overview
10
10
years of professional experience
9
9
years of post-secondary education
Work History
Contracting Specialist
Orsini Pharmaceutical Services, LLC
Elk Grove Village, IL
04.2020 - Current
- Develop and update tracking spreadsheets for contracting efforts.
- Drive contracting efforts through skillful prospecting and credentialing with responsibility for contract negotiations and company marketing initiatives
- Conduct P&L analysis of pharmacy operations/processes and related financial impact to maximize efficiency and cost savings benefits, i.e., examine gross profit, sales, and costs based on prescriptions to determine trends in prescription fulfillment
- Participate in review and evaluation of contractual arrangements and participates in negotiation of final agreements
- Access contract performance data, identify specific revenue enhancement opportunities, and renegotiates contracts to promote improved contract performance
- Develop and manage financially viable contracts coordinating entire contracting process for all potential providers, including prospecting, negotiation, credentialing and orientation
- Credential and re-credential medical staff and facility-based contracted providers and contracted managed care organizations ensuring agreements met organization standards.
Prior Authorization Supervisor
Orsini Pharmaceutical Services, LLC
Elk Grove Village, IL
07.2019 - 04.2020
- Interviewed candidates for both Prior Authorization Team and Enrollment Team.
- Trained new hires on enrollment and billing systems, Rx30 and HMS.
- Hosted weekly team meetings to provide updates regarding processes, new hires, and new therapies.
- Updated, approved, and submitted bi-weekly time cards for employees.
- Performed quality audits on complex therapies and forwarded to Billing Team for final approval.
- Reviewed productivity logs and went over discrepancies with employees.
- Organized patient files and streamlined operations to improve efficiency.
- Answered telephone calls to offer office information, answer questions and direct calls to appropriate department.
- Assisted with verifying eligibility and compliance with authorization requirements for service providers.
Enrollment Supervisor
Orsini Pharmaceutical Services, LLC
Elk Grove Village, IL
08.2018 - 07.2019
- Interviewed candidates for specific complex and specialty therapies.
- Hired, managed, developed and trained staff, established and monitored goals, and conducted performance reviews for team.
- Trained new hires on both enrollment and billing system, Rx30 and HMS.
- Conducted weekly team meetings to discuss updates, new processes and new complex or specialty therapies.
- Updated, approved, and submitted bi-weekly time cards for employees.
- Supervised seven enrollment team members and provided constructive feedback, resulting in higher morale and increased employee retention.
- Reviewed productivity logs and met with individual employees regarding discrepancies.
- Delegated tasks to enrollment staff to organize and improve office efficiency.
- Provided backup to front desk to step in to assist with various tasks whenever employee was absent or at lunch.
Benefits Verification Representative
Orsini Pharmaceutical Services, LLC
Elk Grove Village, IL
01.2017 - 08.2018
- Verified insurance benefits before any medical procedures were performed.
- Contacted insurance companies to determine levels of coverage and benefits information for patients.
- Maintained patient records and paperwork while observing company protocols for data confidentiality.
- Coordinated with contracting department to resolve payer issues.
- Acted as Rx30 and HMS subject matter expert, answering internal and external questions and inquiries.
Mail Order Lead
Orsini Pharmaceutical Services, LLC
Elk Grove Village, IL
08.2015 - 12.2016
- Lead $2.8 million revenue Mail Order Team.
- Trained new hires on Rx30, Virtual Pharmacist, Fastrack, Transnational, Five9, ODI, weekly and bi-weekly Drug Enforcement Administration reporting, and HMS.
- Submitted reports to prescription monitoring programs to meet Board of Pharmacy requirements.
- Reviewed productivity logs and met with individual employees regarding discrepancies.
- Updated, approved, and submitted bi-weekly timecards for employees.
- Developed and maintained monthly team schedule based on business needs.
- Engaged in weekly meetings to discuss billing trends, payer issues, and statistical analysis.
- Analyzed and revised internal processes to reduce company costs, increase efficiency, and improve patient compliance.
Virtual Pharmacist Technician
Orsini Pharmaceutical Services, LLC
Elk Grove Village, IL
12.2014 - 08.2015
- Performed quality audits on daily claims and updated incorrect billing.
- Worked closely with pharmacists to correct inaccurate pharmacy claims.
- Raised revenue by $500k by incorporating best practices to ensure patient and company compliance.
- Kept track of billing trends and discuss with Director of Contracting.
- Managed inventory by ordering daily specialty medication and supplies.
- Key point of contact for rejected claims and high priority cases.
- Met with team supervisors to discuss billing trends and employee billing errors.
Intake Biller
Orsini Pharmaceutical Services, LLC
Elk Grove Village , IL
12.2013 - 12.2014
- Executed billing tasks and recorded information in company databases.
- Contacted patients with past due accounts to formulate payment plans and discuss restructuring options.
- Reached out to patients to sign up for financial assistance program to cover prescription costs.
- Developed rapport with patients and pharmacy insurance plans to cultivate loyalty and satisfaction.
- Handled high volume of in-bound calls pertaining to reconciliation of delinquent accounts.
- Worked effectively with payers such as Medicare, Medicaid, commercial insurances to obtain timely and accurate payments.
- Kept daily log of outstanding balances, payments, financial assistance program enrollments and reported daily to Team Lead.
Customer Service Representative
Orsini Pharmaceutical Services, LLC
Elk Grove Village, IL
02.2012 - 12.2013
- Maintained customer satisfaction with forward-thinking strategies focused on addressing customer needs and resolving concerns.
- Provided primary customer support to internal and external customers.
- Responded to customer requests for products, services and company information.
- Consulted with various departments to resolve discrepancies and create expert solutions.
- Answered customer telephone calls promptly to avoid on-hold wait times.
- Investigated and resolved customer inquiries and complaints quickly.
- Followed up with customers about resolved issues to maintain high standards of customer service.
Education
Bachelor of Arts - Human Resources Development
Northeastern Illinois University
Chicago, IL 12.2019 - 12.2021
Bachelor of Arts - Communication
Northeastern Illinois University
Chicago, IL 08.2005 - 12.2012
Skills
MS Office
Training and Development
Critical Thinking
Problem-Solving
Attention to Detail
Flexible and Adaptable
ADP
Timeline
Contracting Specialist
Orsini Pharmaceutical Services, LLC
04.2020 - Current
Bachelor of Arts - Human Resources Development
Northeastern Illinois University
12.2019 - 12.2021
Prior Authorization Supervisor
Orsini Pharmaceutical Services, LLC
07.2019 - 04.2020
Enrollment Supervisor
Orsini Pharmaceutical Services, LLC
08.2018 - 07.2019
Benefits Verification Representative
Orsini Pharmaceutical Services, LLC
01.2017 - 08.2018
Mail Order Lead
Orsini Pharmaceutical Services, LLC
08.2015 - 12.2016
Virtual Pharmacist Technician
Orsini Pharmaceutical Services, LLC
12.2014 - 08.2015
Intake Biller
Orsini Pharmaceutical Services, LLC
12.2013 - 12.2014
Customer Service Representative
Orsini Pharmaceutical Services, LLC
02.2012 - 12.2013
Bachelor of Arts - Communication
Northeastern Illinois University
08.2005 - 12.2012