Shanda Veney

Responsible for auditing client and benefit setup.

· Validates Client Specific Benefits testing.

· Performs comprehensive group setup audits to identify processor accuracy and/or compliance issues to ensure quality setup for clients.

· Responsible for quality review of medical product/benefit accuracy, pharmacy, and other ancillary products.

· Analyzes error trend data and shares trends and opportunities with leadership.

· Supports testing and validation activities for all annual portfolio builds.

• Served as primary point of contact managing day to day activities of patient and health care provider support requests and deliverables across multiple communication channels i.e
• Phone, fax, chat, email, etc
• Responsible for quality review and audit of health plans to ensure patients qualified for programs being offered
• Performed audits/quality review of COBRA, Medicare, Medicaid, and commercial insurance plans
• Onboarded and educated healthcare providers and external partners on available resources and procedures to ensure timely case processing based on business rules
• Established customer touchpoints and preferred communication methods
• Partnered with FRMs and/or account directors on account business reviews and conduct virtual or field visits
• Ensured all support requested was captured within the case management system
• Ensured timely processing and resolution of cases
• Managed escalations of complex cases, when appropriate
• Coordinated all appropriate aspects of patient case management through to completion, using effective people skills to manage interactions
• Provided actionable insights and solutions around access trends
• Acted as a Subject Matter expert on key focus areas, such as Buy and Bill, Patient Savings Program, Pharmacy Coordination, etc
• Prepared and delivered presentations, and training to various audiences summarizing service offerings, service utilization, actionable insights, and continuous improvements areas

• Assisted in identifying study sites by performing site feasibility and recruitment tasks, e.g., completing, disseminating, and reviewing responses to site recruitment questionnaires
• Completed essential document collection and review throughout the study lifecycle inclusive of site activation
• Organized and maintain site clinical trial master file (TMF) documents
• Set up and maintained site-related data in applicable clinical systems according to procedures and guidelines
• Acted as primary site contact/liaison for study and site management issues including addressing questions, inclusive of protocol questions, managing study supplies and conducting offsite central monitoring visits/contacts (pre-study, initiation, monitoring and close out visits)
• Escalated issues and risks as needed
• Ensured timely and complete data entry by site
• Performed data review inclusive of site level data review, query resolution, facilitate database closure and freezing procedures as per study plans
• Performed risk assessment and management responsibilities throughout the project including site process evaluation, addressing follow up items and issue escalation
• Performed all tasks in accordance with applicable guidelines, (e.g., ICH-GCP), company and sponsor SOPs, project plan, study specific processes, local regulatory requirements

• Responsible for managing the resolution for appeal scenarios for Medicare Part D products and grievance
• Responsible for RxCaims benefits auditing
• Responsible for quality review and audit of health plans to ensure patients qualified for programs being offered
• Performed audits/quality review of Medicare and commercial health insurance plans
• Identified and researched all components within member appeals
• Served as a technical resource to colleagues on claim research
• Ensured timely, customer focused response to appeals
• Responsible for coordination of all components of appeals
• Identified trends and emerging issues and reports on and gave input on potential solutions
• Followed up to assure appeal was handled within established timeframe to meet company and regulatory requirements
• Ran reports and claims processing