Ori Maris

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.

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.

Performed diverse pharmacy operations, including patient orientation, purchasing, warehouse management, reception, Rx processing, and sales. Provided coverage for absent personnel across various departments.

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.

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.

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.

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

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.

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.

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.