Spencer Schultz

Developed financial models and analysis to identify impact of changes to existing formularies and drug programs, as well as explore new opportunities for savings. Managed relationships with external partners during monthly stakeholders meetings and quarterly reviews. Used SAS to develop forecasts that informed decisions related to client opportunities. Researched industry specific regulations related to new state statutes and ensured compliance with applicable laws. Assessed risk associated with current market trends and provided recommendations for mitigating those risks. Collaborated with internal stakeholders to ensure timely completion of projects while meeting customer expectations. Presented the data to the clients in a manner that concisely conveyed the logic and methodology the reports were built on. Answered client questions surrounding estimates and models.

Prepared over $1 billion in Manufacturer Discount (Rebate) Disbursement payments. Maintaining multiple system setups for more than 150 clients. Providing regular reporting to clients as well as ad hoc report requests including but not limited to internal and external auditors, state and government regulatory agencies, C-suite and ELT reports, as well as individual client requests on a per case basis. Seeking out process gaps that can be closed, automation opportunities, and ways to improve quality control. Specializing in analysis of contracts as they pertain to rebates and providing feedback to leadership that has enabled us to become more profitable and has positively improved client-relations.

Pulled claims data via SAS tool. Filtered out non-impacted claims for reprocessing. Reprocessed potentially impacted claims. Determined financial impact through Claims Analysis. Reported impact of errors in RxClaims. Daily Reject Reporting. Reprocessing and reporting specialty coupon claims associated with a rebate program. Provided key input to dramatically turn a team with an exceptionally large work-backlog into a team that meets/exceeds turnaround time expectations while improving average team production to a greater than 300% production output in less than 2 years.

Delegated the responsibilities of the team's technicians and communicated with the on call supervisors and physician reviewers. Other responsibilities included troubleshooting/resolving technical issues and forecasting potential problems, as well communicating with pharmacists/technicians to answer any technical/forecasting questions. Managed the Clinical Review Inquiries and IVL email boxes, while handling all cases that had been Upgraded to Urgent and all of our team's CRU Denial Outreach for the day. Reviewed urgent cases across all clients and closed cases that were pending before their turnaround time limit.

Reviewed and processed Prior Authorization requests for Blue Cross Blue Shield members. Processed claims for different Utilization Management programs including Step Therapy, Quantity Exceptions, Formulary Exceptions and High Dollar reviews. Applied a working knowledge of Lotus and RxCLAIM systems with additional databases and resources to determine the final outcome of clinical review requests. Analyzed review criteria, streamlined process flow and conducted outreach to ensure compliance with Clinical Review standards.

Coordinated with pharmacies when sending and receiving medication orders. Administered medication and treatments prescribed to residents. Supervised resident assistants. Responsible handling of medication with regards to patient safety/privacy and medication security. Accurate documentation of medication and treatment administration.