Valarie Smith, CPhT, MBA

Experience

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  Springer Clinic

  Oct 1988 - Nov 1990

  Billing and Office Representative

  Assisted with floater duties, including registering patients in various educational programs offered, as well as aiding educators with evening courses. Performed front-desk tasks, including greeting and checking in patients, and assisting with follow-up appointments. Balanced float duties between office support and medical billing, medical records, and front-office relief. Reorganized medical filing structure at new clinic office, contributing to increased efficiency in locating patient files. Supported nursing staff. Show less

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  Health Care Service Corporation

  Nov 1990 - Jun 2017

  Collaborated with internal partners (marketing, clinical pharmacy, and government program teams, as well as pharmacy benefit manager) to improve member experience when visiting pharmacy to obtain prescription. Defined and developed departmental goals and priorities targeted at production readiness of pharmacy benefits for custom large group, Healthcare Insurance Marketplace, and Medicare and Medicaid business. Created and implemented operational process enhancements, created annual forecast supported by development of staffing model, managed and owned multiple projects, and provided executive status updates to leadership team.Participated in leadership meetings regarding overall performance of division in developing balanced scorecard measurement activities to provide transparency in speed, quality, and division’s operational cost. Maintained working relationships with vendors, department leaders, and legal team. Managed budget, staffing, pharmacy benefit, and inventory. Implemented clinical programs and managed inventory operating statistics and data. Developed management reports and presentations, including status report read-out at senior management meetings and dashboard reporting. - Served as pharmacy operation lead for new business acquisitions and merger and business lead for pharmacy eligibility system enhancements. - Implemented pharmacy benefits for approximately 3,000,000 Blue Plan members. Show less Supervised implementation of pharmacy benefits, pharmacy network contracting, specialty medication pricing review, and implementation of legislative requirements. Represented pharmacy departments at client meetings by providing pharmacy benefit design recommendations, as well as researching and responding to written and verbal pharmacy inquiries and pharmacy claim and pricing audits. Managed and developed team of direct reports. Led merger and acquisition of other Blue Plans, and assumed lead roles in proposing and on-boarding new pharmacy benefit manager.Created department goals and measurements, conducted performance reviews, managed department budgets, and provided executive readouts to department’s performance. Ensured timely coding of pharmacy benefits, supporting government, retail, and commercial business. Developed and implemented system enhancements, pharmacy contract language, legislative (federal and state) requirements, and clinical programs. Communicated with pharmacy benefit manager to support and test various project initiatives, pharmacy and therapeutic committee, and mergers and acquisitions. - Oversaw pharmacy operations for enterprise after Deloitte Consulting firm conducted process analysis and rewarded team for best pharmacy operations process. - Implemented pharmacy benefits for five states (previously only responsible for Texas). - Completed RFP and implemented new specialty pharmacy vendor. - Led pharmacy operations team on acquisition and merger of new business. Show less Oversaw multiple projects, conducted client site visits, on-boarded new internal systems, and developed internal and external communication materials. Led development of small- group sales software for brokers, consultants, and sales representatives; created processes to support review and logic build of custom medical and pharmacy benefit request; and designed marketing paperwork to thoroughly document medical and pharmacy benefits sold to clients. Managed, tested, and implemented various efforts supporting Texas marketing and sales team, including non-standard benefit request process and Texas benefit coding matrices; defined system requirements and tested small-group rating software program. Show less Collaborated with various departments to obtain details needed to effectively create written and verbal response to inquiries and resolve escalated inquiries. Investigated legal inquiries and class-action suits requiring special and confidential examination, potentially leading to termination of employees and legal representatives, and arrest of healthcare providers engaged in illegal activities. Managed claim and inquiries related to legal cases from lawsuits, fraudulent investigations, and highly-confidential cases. Show less

  • Sr Manager Subscriber Services

    Jan 2016 - Jun 2017

  • Manager Enterprise Pharmacy Coding and Support

    Feb 2001 - Jan 2016

  • Marketing Support Administative Specialist

    Sept 1996 - Feb 2001

  • Unit Leader Member Customer Service

    Sept 1995 - Sept 1996

  • Executive Office Customer Service Representative

    Sept 1994 - Sept 1995

  • Member Customer Service Representative

    May 1991 - Sept 1994

  • Data Entry Representative NonDuplication Department

    Nov 1990 - May 1991
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  CVS Health

  Oct 2017 - now

  Clinical Client Operations Senior Manager

  Operational leadership providing direction for commercial, Medicaid, and Medicare with a focus on Specialty Pharmacy Coding operations. Leading quality improvement, developing policy and procedures, workflow management, and capacity planning. In addition to daily operational oversight, support and analyze requests from Account Management, translate client requirements and staff development.