Chekesha D. West19 Hamil Court Clifton, NJ 07013

lcwtrinity@yahoo.com(973) 225-9441

Objective: To improve quality and performance by obtaining a challenging position in a progressive service focused HealthCare Organization.

Experience:November 2014 – Present Axelon Services Corp NY, NY@Horizon BCBSNJ 3 Penn Plaza Newark, NJ Pharmacy Services-Build Team Title: Benefit Specialist I • Acts as liaison between Client of New Jersey account management areas and the PBM vendor to resolve various benefit and service issues.• Manages the PBM interfaces, and recommends solutions to any systems related issues.• Acts as the primary contact to the PBM vendor on all issues related to our contractual arrangement with groups on benefit setup.• Assists with ongoing analysis and assessment of PBM vendor performance Works with vendors to outline action plans to comply with requirements and standards.• Ensures operational compliance with PBM vendor to support MBU pharmacy sales and marketing effort.• Coordinates the development of ongoing training programs, materials and communication with our PBM vendor to improve operational efficiency.• Performs data retrieval and analysis required to guide sales strategic and tactical goals.• Provides sales and marketing with account specific reports to guide Sales in group and member reconciliation• Research and inventory national benefit designs and measure accuracy of benefit setup. Upon completion of research and measurement make determination if correction is needed then proceed with modifying existing benefit designs.• Assists sales with competitive intelligence gathering of datasets and measurement of trends. • Provide feedback of current performance relative to benchmark.• Support internal Pharmacy Sarbanes-Oxley Liaison. Create and maintain all necessary documentation, identify gaps and remediate accordingly.

March 2006 – September 2013 Medco/Express-Scripts Inc. Franklin Lakes/Montvale, NJ Pharmacy Benefit Management Title: Account Coordinator• Responsible for identify opportunities and possible oversights within client installations to assist in maintaining the accuracy of detail while clarifying points of intent as it relates to set up. • Install member files to connect to Open Enrollment builds. Confirm enrollment of individuals and groups. Review and manage Open Enrollment coordinating with team members & functional areas. • Accountable for managing the client relationship and internal resources to resolve service related issues within the contractual turnaround times.• Responsible for reviewing member issues that reached the employee benefits manager level, the presidential issues level or the complex customer service resolutions level. Calculated overpayments, confirmed appropriate manufacturer pricing, approval amounts and program discounts/pricing as to be applied per contract. • Responsible for researching, reporting, projecting and managing individual adjustments and client group mass adjustments. • Responsible for documenting all client-related service issues using the appropriate software/tools.• Manage overviews of additional issue resolution done by other teams while interacting with Engagement Band and internal departments.

• Manage, build and deliver client reports on an ongoing basis as requested per client.• Investigates client/build issues to determine root cause and prevention. • Communicate unique client requirements to member facing areas to assure proper handling of complex set ups, in addition, assist in making sure custom IBAAGs are updated / maintained. • Coordinate and attend internal meetings for resolution of issues and help develop workaround strategies when solutions are not immediately available • Helps retain/renew assigned accounts by meeting or exceeding service level objectives. • Assist United/ NAE in conducting frequent reviews of plan information for the client. • Assisted in conducting pre & post-installation account set-up audits as requested and/or required. • Performed special project work during the transition including exit audits.

October 2002 – December 2003 Quality Home Care Providers Inc. Leonia, NJRespiratory Therapy/DME & Pharmacy Title: Billing Manager/ Acct Specialist• Managed Billing Department External Operations/Accounts Management in the following areas: [Obtained & maintained changes in individual insurance company policies, contract renewals, authorizations, performed reconciliation for contracted insurance groups, performed and managed 1st and 2nd level Appeals for Commercial, Medicaid & Medicare also assured proper billing & collections]. • Managed Billing Department Internal Operations while simultaneously performing the full duties of an account representative in the following areas: [providing daily assignments to staff, correspondence, phone unit operations, policy updates, interdepartmental training/education, collections, and account adjudication]. • Liaison and overseer for the Satellite Office. Assisted in problem resolution, investigations, account receivables reconciliation and appeals. • Created job ads, position descriptions and assisted in the interview process for billing representative positions. • Created and Implemented various forms/letters and policies to improve functional quality, reduce accounts receivable and handle legal issues for both the Client Services Department and the Billing Department. • Responsible for data entry & maintenance of the purchasing system including product descriptions, purchase coding, pricing for in-house products & Medicare/Medicaid retail information.• Provided Technical support for system upgrades and new system implementations. • Performed internal studies, project management, tracked, reported & projected earnings.

Education: 1992-1993 Saint Peter’s College Jersey City, NJ

Major: International Business, Marketing / Management.

Grade Point Average: 3.5

Highlights: Provided Quality Review for the Medco/Express-Scripts Inc. Transition.

Consistent track Record of High Quality Metrics and Production.

Recipient of multiple Awards and Happy Letters.

Saint Peter’s Dean’s List

Special Skills: Filing, Data Entry, Investigations, Microsoft Word, Excel, Power Point, Superb Telephone Communication Skills, Typing 40- 45 W.P.M., some Spanish.

References: Furnished upon request.