Patrick Cambel

Experience

• 

  CVS

  Jun 2007 - Feb 2009

  Pharmacy Technician
• 

  MedImpact Healthcare Systems, Inc.

  Mar 2009 - Dec 2012

  • Formulated and modified audit strategies and plans, and related services, to meet organizational and client needs• Established standards and procedures for the quality and timeliness of work to ensure accuracy in identifying exposures, documenting potential risk areas for company and/or clients• Oversaw the development of and conducted training of client audit staff• Provided day-to-day oversight of department, including developing and administering policies, business processes and quality standards• Ensured that deliverables are within budget and meets the quality levels expected by internaland external customers• Developed and maintained reporting tools for the department, pharmacies, and clients• Responsible for intervening and resolving issues, problems, and/or concerns from clients, and informing senior management regarding client issues that may have an adverse impact• Responsible for "Performance Guarantee (PG) Reporting" which included the following: o Oversight of claims auditing of Benefit Change Requests and system adjudication accuracy o Facilitation and collection of PG results from process owners and preparation of PG client reports on a monthly and quarterly basiso Quarterly and annual PG reconciliations to determine penalty payouts, and related communications with account teams and clients o Research into PG failures encompassing communications with process owners, client, and account team, as necessary, Preparation of Missed PG Reporting schedule for senior leadership o Respond to HEDIS (Healthcare Effectiveness Data and Information Set published by NCQA) requests from clients and account teams and prepares related reports and communications Show less Lead and conducted retail pharmacy audits to ensure compliance with government regulations and decrease fraudDocumented and made adjustments to pharmacy claims as determined by audit findings to ensure integrity and accuracyDeveloped, implemented, and maintained the pharmacy network audit and fraud waste and abuse programs, including writing and revising policies and procedures, communicating program features, ensuring clear roles and responsibilities, measuring and reporting results, and recommending enhancements.Ran reports, selected network pharmacies for in-depth audits, coordinated on-site audit schedules, and ensured timely completion and reporting of results. Partnered with other business units to effectively resolve customer issues and inquiries, implement new business, and design solutions that meet the mutual needs of the business and thier customers, actively participated as a member of cross functional workgroups, teams, and committees as assigned, and assisted with desktop, document and verification (D&V), and on-site audits. Show less Entered through the PBM Operations Trainee program with high accuracy scores and gained working experience in the following departments: Customer Service, Prior Authorizations, and Benefits.Reviewed and analyzed test claims to ensure client business requirements were met and claims paid and processed appropriately with POS adjudication. Created custom automated coding template scripts for repetitive coding processes. Served as a subject matter expert for the implementation of automated scripting for benefit coding. Show less

  • Manager, Audit

    Feb 2012 - Dec 2012

  • Provider Audit, Fraud, Waste, and Abuse

    Jul 2010 - Feb 2012

  • Benefits Managment Coordinator

    Mar 2009 - Jul 2010
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  Milliman

  Dec 2012 - now

  Senior Pharmacy Management Consultant

  Healthcare Consulting, Pharmacy Benefits Consulting, Pharmacy Benefit Manager (PBM) Audit, Pharmacy Benefit Manager Request for Proposal (RFP), Retiree Drug Subsidy Reconciliation and Audit, Medicare Part D, Data Validation, Pharmacy claims analysis, Pharmacy claims reporting, data analysis