Looking for a job

Andrea Maynard

@andreamaynard

Message

Exceptional PBM/healthcare compliance analyst with 8+ years of experience

United States

Message

What I'm looking for

Seeking a challenging role in healthcare compliance where I can utilize my skills and experience to drive business growth and improve outcomes.

As a seasoned healthcare compliance analyst with over 8 years of experience, I have developed a strong background in business process analysis, quality assurance, and data analysis. My expertise lies in pharmacy benefit management, claims payment and analysis, and managed care information systems. I am proficient in advanced Microsoft Applications and have a proven track record of enhancing system reliability, improving operational efficiency, and ensuring regulatory compliance.

Throughout my career, I have worked with various healthcare organizations, including PMA Management Corp and Envision Rx Options, where I have demonstrated my ability to extract and integrate data, conduct quality assurance audits, and develop policies and procedures to enhance operational consistency and regulatory compliance.

I am a results-driven professional with excellent problem-solving and issue resolution skills, and I am committed to delivering high-quality results in a fast-paced environment. I am confident in my ability to leverage my skills and experience to drive business growth and improve healthcare outcomes.

Experience

Work history, roles, and key accomplishments

Compliance/Operations and Service Coordinator

PMA Management Corp

Oct 2022 - May 2024 (1 year 7 months)

Led data extraction and integration from previous administrators, conducted quality assurance audits on claims, and developed compliance policies to enhance operational consistency. Prepared detailed audit reports for the Account Management team, providing insights for service quality improvement.

Data Integration Quality Assurance Audit Reporting Policy Development Claims Management Regulatory Compliance Client Management Process Improvement

Quality Assurance Specialist

Envision Rx Options

Apr 2021 - Jun 2022 (1 year 2 months)

Managed client requests and provided support while developing quality reports and dashboards. Conducted training for new hires and facilitated calibration sessions to improve service quality and operational efficiency.

Client Services Reporting Data Analysis Dashboards Training Communication Skills Quality Improvement

PBM Oversight Specialist

Envision Rx Options

Jun 2016 - Jun 2022 (6 years)

Analyzed claims and managed benefits in pharmacy benefit management, ensuring compliance and integrity for CMS audits. Enhanced system reliability through structured testing and managed claims processing.

Claims Management Benefits Administration Data Analysis Compliance Testing Microsoft Excel Fraud Detection

PBM Customer Service Representative

Envision Rx Options

Jun 2015 - Jul 2016 (1 year 1 month)

Managed high-volume calls to resolve inquiries regarding prescription benefits and claims processing. Assisted patients and providers with PBM services while ensuring compliance with regulations.

Customer Service Claims Compliance Communication Problem Solving Data Integrity Cross Functional Collaboration

Legal Accounts Resolution Specialist

Weltman, Weinberg, and Reis

Nov 2010 - Jun 2015 (4 years 7 months)

Developed debt resolution strategies and collaborated with healthcare facilities to validate claims data. Prepared legal documents and provided high-quality customer service to enhance client satisfaction.