Patrick Biela
Delivery Management Analyst II. Provider Relations Lead #PBM | #LSSBB #leanexpert #Medicaid #Medicare #quality #PDCA
- Role
- Delivery Management Analyst Ii Provider Relations Lead at Conduent
- Location
- Boston, MA, US
- LinkedIn followers
- 500 followers
About Patrick Biela
Healthcare operations professional with 10+ years managing clinical operations, provider…
Experience
Delivery Management Analyst Ii Provider Relations Lead
Aug 2022 — Present · Boston, MA, US
establishes and maintains relationships among the state\'s pharmacy program for drug and related services.educates pharmacies and prescribers on MassHealth regulationsWork with other agencies and stakeholders for pharmacy claims resolutions.• Conduct annual provider training management for pharmacists and technicians• Oversee call center services (resolving escalated tickets, providing training, and providing reporting• Evaluates and responds to claims processing discrepancies• Provide software vendor certification, pharmacy claim recovery, and new provider claim testing • Provides implementation support to new pharmaciesIs a mediator between pharmacies and software vendors for claim/system adjudication • Primary contact for pharmacists and pharmacy technicians seeking assistance with electronic pharmacy claims billingExecutes effective responses to all issues from the call center • Assists with drug rebate reporting and reconciliation• Performs claims adjudication and metrics analysis• Gives quarterly presentations to Pharmacy director and pharmacy teamIdentify and resolve operational problems using defined processes, expertise and judgment, and understand the upstream/downstream impactsIdentify, track, and monitor applicable performance metrics/trends
Education
Learnquest
Scrum Master Specialization
Skillsoft
Agile For All
UC Irvine
Introduction to Business Specialization
Digital Marketing Institute
Digital Marketing Strategy and Planning Specialization
Springfield College
Bachelor of Science - BS, Applied Exercise Science
2003 — 2007
South Hadley High School
High School/Secondary Diplomas and Certificates
1999 — 2003
UC Irvine
Introduction to Financial Accounting: The Accounting Cycle Specialization
University of Geneva
Investment Management Specialization
New York Institute of Finance
Risk Management Specialization
Alison
Kaizen Approach - Lean Methodology for Continuous Improvement
Skills
- Fitness
- Adobe Design Programs
- Powerpoint
- Data Management
- Hospitals
- Health Advocacy
- Social Media
- Coaching
- Quickbooks
- Sharepoint
- Medical Records
- Leadership
- Salesforce
- Neurological Disorders
- Healthcare
- Wordpress
- Data Entry
- Health Insurance
- Adobe Illustrator
- Exercise Physiology
- Special Education
- Teaching
- Health Education
- Management
- Qlikview
- Sports Coaching
- Microsoft Office
- Spanish
- Public Speaking
- Conflict Management
- Behavior Management
- Spss
- Customer Service
- Medicine
- Mmis
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