Ori Maris
@orimaris
Dynamic pharmacy professional with over 12 years of experience.
What I'm looking for
I am a dedicated pharmacy professional with over 12 years of experience in the industry. My journey has equipped me with a diverse skill set, ranging from claims auditing to patient care. I thrive in dynamic environments where I can leverage my bilingual abilities and extensive knowledge of pharmacy operations to enhance patient outcomes and streamline processes.
Throughout my career, I have successfully managed various roles, including Claims Auditor and Prior Authorization Agent, where I developed and implemented improvement plans that significantly increased operational efficiency. My commitment to teamwork and customer service has allowed me to build strong relationships with colleagues and clients alike, ensuring that I can effectively address any challenges that arise.
Currently pursuing a Master of Business Administration with a concentration in Health Services Quality, I am eager to continue growing professionally and contribute to a stable company that values innovation and employee development. I am passionate about utilizing my skills to make a meaningful impact in the healthcare sector.
Experience
Work history, roles, and key accomplishments
Claims Auditor
Caribe Pharmacy Holdings
Jan 2024 - Present (1 year 5 months)
Currently performs claims audits, reviews, and processes, including validating margins, negative prices, and MAC or AWP in the Rx30 system. Presents audit findings and develops implementation plans for management.
Prior Authorization Agent
Caribe Pharmacy Holdings
Jan 2023 - Present (2 years 5 months)
Managed PBM transactions (Part D) claims for Medicare and other companies, including COB claims. Reviewed medical records and conducted prior authorization processes or claims rejections with various insurance companies, discounts, and patient assistance programs.
Floater Pharmacy Technician
Alivia Specialty Pharmacy
Jan 2020 - Present (5 years 5 months)
Performed diverse pharmacy operations, including patient orientation, purchasing, warehouse management, reception, Rx processing, and sales. Provided coverage for absent personnel across various departments.
Fulfillment Pharmacy Technician
Specialty Pharmacy Axium Healthcare Puerto Rico
Jan 2019 - Present (6 years 5 months)
Managed inventory, developed improvement plans, and handled labeling, packaging, and dispensing of specialty medicines. Managed Hazard drugs, LDD, and REMS programs, along with various therapy medications. Filed prescriptions according to PR pharmacy law and enrolled patients in pharmaceutical trials.
Oncology Pharmacy Technician
Specialty Pharmacy Axium Healthcare Puerto Rico
Jan 2016 - Present (9 years 5 months)
Processed and handled the REMS program with Celgene, and translated and profiled Oncology prescriptions using the CPR+ app. Calculated and clarified dosages, managed medical billing with PBM transactions (Part D) for Medicare and other companies, and handled calls from patients, providers, manufacturers, and insurance companies.
Administration and Management Intern
Cardiovascular Center of Puerto Rico and the Caribbean
Jan 2016 - Present (9 years 5 months)
Audited patient medical records following Uniform Data System (UDS) standards and assisted in developing improvement plans. Prepared presentations of audit findings and discussed outcomes with committees. Provided training to new staff on systems, policies, regulations, and standards, and assisted with employee time management and staff supervision.
Lead Pharmacy Technician
Telemedik
Jan 2012 - Present (13 years 5 months)
Trained new staff on company systems, policies, regulations, and standards, and managed employee time and scheduling. Conducted audits for URAC preparation, including MTM records. Provided orientation to pharmacy staff and providers on prior authorization processes, step therapy, and claim rejections, and managed insurance system overrides for PBM claims processing. Utilized various healthcare app
Education
Degrees, certifications, and relevant coursework
Universidad Central de Bayamón
Master of Business Administration, Health Services Quality
Currently pursuing a Master of Business Administration with a concentration in Health Services Quality. This ongoing program focuses on enhancing knowledge and skills in managing and improving healthcare services.
Sistema Universitario Ana G. Méndez
Bachelor’s Degree, Public Health Administration
Completed a Bachelor’s Degree in Public Health Administration with a concentration in Services Health Management. The curriculum provided a comprehensive understanding of public health principles and healthcare service delivery.
National University College
Associate Degree, Pharmacy Technician
Obtained an Associate Degree in Pharmacy Technician, providing foundational knowledge and practical skills in pharmacy operations. This education prepared for a licensed role in the pharmacy industry.
Availability
Location
Authorized to work in
Job categories
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