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  • Ricardo Vaughan Resume

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    Ricardo Vaughan
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    Ricardo Vaughan / Des Plaines, IL / rvaughan3@gmail.com / 847-409-2705 University of Illinois at Urbana-Champaign Bachelor of Science in Health Planning and Administration, May 2011  Calculus III, Acc. Chemistry II, Health Care Systems, Health Services Financing, Health Administration, Advanced Topics in Communication, Public Speaking WORK EXPERIENCE Optum Schaumburg, IL Industry Relations Specialist, 2016  Manage pharmacy MAC pricing reviews. Diligently uphold review standards in the appeal process and quality assurance, disregarding inadequate reviews. Examine purchase price of drugs, NDC, compounds, Rx no., NCPDP, BIN, PCN, and Filled Date  Create MAC reports, pharmacy fax responses, research appeal history and origin in various databases, run queries for appeal resolution, maintain information security operations.  Work with team to discuss client preferences, new state laws, collaborate with Rx Reimbursement Team Catamaran Schaumburg, IL Clinical Operations Specialist, 2015  Responsible to work independently or cooperatively with team members to create, program, set up and maintain pharmacy benefit applications, ex. RxAUTH: efficient prior authorization (PA) management service that automates the PA process for clients.  Maintain a high level of consistency and integrity to interpret a variety of instructions in order to program them and work with management to operationalize them. Also communicate those instructions to a group or individual PA specialist.  Attend regular meetings as a forum to effectively communicate progress and QA feedback to management, and bring up any issues, concerns or give any other updates.  Use knowledge of quality control, Pharmacy Benefit Management, and Health Insurance Industry to provide excellent customer service, maintain all updates, changes to requirement schedules, PA details, and GPI lists per client request. Alexian Brothers Behavioral Health Hospital Hoffman Estates, IL Physician Health Record Controller, 2014  Diligently trained in new CPOE quality improvement module, successfully transcending minimal standards.  Taught doctors to enter labs, procedures, nursing interventions, diets, customizing module, medications, eliminating duplicate orders, potential for discharge, and sign orders.  Quickly resolve physician issues and concerns to effectively implement patient care.  Create reports trending physician activities and disputes within departments in order to direct resolution.  Lead and coordinated team to effectively cover hospital rounds while promoting cooperation. WellCare Health Plans, Inc Chicago, IL Quality Improvement Specialist, 2013  Collaborate with hospital and health care staff to properly request and transferred medical records to complete the Healthcare Effectiveness Data and Information Set (HEDIS) quality assessment review.  Carefully conducted and recorded 81 quality measure requirements for HEDIS pertaining to Effectiveness of Care, Access/Availability of Care, Experience of Care, and Health Plan Descriptive Information.  Cross-reference multiple software such as XCELYS 6.1 that executes several extended business functions which increases quality and benefits for health plan administration. Along with EMMA 2.5 that maintains accurate records of case management activities, in order to research patient, doctor, and claim information.  Completed HIPAA Compliance for Health Plans 2013, training that portability and continuity of health insurance. St. Alexius Medical Center Hoffman Estates, IL Physician Health Record Controller, 2012  Quickly understood new EHR software after a week of training.  Tutor physicians how to effectively use software, such as: rounding list, build cover, current/past visits, vital signs, medications, and order test. Golf Maine Park District Niles, IL Commissioner, 2016  Hire and train director. Set goals, formulate policies, and establish

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    Ricardo Vaughan / Des Plaines, IL / rvaughan3@gmail.com / 847-409-2705 University of Illinois at Urbana-Champaign Bachelor of Science in Health Planning and Administration, May 2011  Calculus III, Acc. Chemistry II, Health Care Systems, Health Services Financing, Health Administration, Advanced Topics in Communication, Public Speaking WORK EXPERIENCE Optum Schaumburg, IL Industry Relations Specialist, 2016  Manage pharmacy MAC pricing reviews. Diligently uphold review standards in the appeal process and quality assurance, disregarding inadequate reviews. Examine purchase price of drugs, NDC, compounds, Rx no., NCPDP, BIN, PCN, and Filled Date  Create MAC reports, pharmacy fax responses, research appeal history and origin in various databases, run queries for appeal resolution, maintain information security operations.  Work with team to discuss client preferences, new state laws, collaborate with Rx Reimbursement Team Catamaran Schaumburg, IL Clinical Operations Specialist, 2015  Responsible to work independently or cooperatively with team members to create, program, set up and maintain pharmacy benefit applications, ex. RxAUTH: efficient prior authorization (PA) management service that automates the PA process for clients.  Maintain a high level of consistency and integrity to interpret a variety of instructions in order to program them and work with management to operationalize them. Also communicate those instructions to a group or individual PA specialist.  Attend regular meetings as a forum to effectively communicate progress and QA feedback to management, and bring up any issues, concerns or give any other updates.  Use knowledge of quality control, Pharmacy Benefit Management, and Health Insurance Industry to provide excellent customer service, maintain all updates, changes to requirement schedules, PA details, and GPI lists per client request. Alexian Brothers Behavioral Health Hospital Hoffman Estates, IL Physician Health Record Controller, 2014  Diligently trained in new CPOE quality improvement module, successfully transcending minimal standards.  Taught doctors to enter labs, procedures, nursing interventions, diets, customizing module, medications, eliminating duplicate orders, potential for discharge, and sign orders.  Quickly resolve physician issues and concerns to effectively implement patient care.  Create reports trending physician activities and disputes within departments in order to direct resolution.  Lead and coordinated team to effectively cover hospital rounds while promoting cooperation. WellCare Health Plans, Inc Chicago, IL Quality Improvement Specialist, 2013  Collaborate with hospital and health care staff to properly request and transferred medical records to complete the Healthcare Effectiveness Data and Information Set (HEDIS) quality assessment review.  Carefully conducted and recorded 81 quality measure requirements for HEDIS pertaining to Effectiveness of Care, Access/Availability of Care, Experience of Care, and Health Plan Descriptive Information.  Cross-reference multiple software such as XCELYS 6.1 that executes several extended business functions which increases quality and benefits for health plan administration. Along with EMMA 2.5 that maintains accurate records of case management activities, in order to research patient, doctor, and claim information.  Completed HIPAA Compliance for Health Plans 2013, training that portability and continuity of health insurance. St. Alexius Medical Center Hoffman Estates, IL Physician Health Record Controller, 2012  Quickly understood new EHR software after a week of training.  Tutor physicians how to effectively use software, such as: rounding list, build cover, current/past visits, vital signs, medications, and order test. Golf Maine Park District Niles, IL Commissioner, 2016  Hire and train director. Set goals, formulate policies, and establish

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    67 просмотров2 страницы

    Ricardo Vaughan Resume

    Загружено:

    Ricardo Vaughan
    Ricardo Vaughan / Des Plaines, IL / rvaughan3@gmail.com / 847-409-2705 University of Illinois at Urbana-Champaign Bachelor of Science in Health Planning and Administration, May 2011  Calculus III, Acc. Chemistry II, Health Care Systems, Health Services Financing, Health Administration, Advanced Topics in Communication, Public Speaking WORK EXPERIENCE Optum Schaumburg, IL Industry Relations Specialist, 2016  Manage pharmacy MAC pricing reviews. Diligently uphold review standards in the appeal process and quality assurance, disregarding inadequate reviews. Examine purchase price of drugs, NDC, compounds, Rx no., NCPDP, BIN, PCN, and Filled Date  Create MAC reports, pharmacy fax responses, research appeal history and origin in various databases, run queries for appeal resolution, maintain information security operations.  Work with team to discuss client preferences, new state laws, collaborate with Rx Reimbursement Team Catamaran Schaumburg, IL Clinical Operations Specialist, 2015  Responsible to work independently or cooperatively with team members to create, program, set up and maintain pharmacy benefit applications, ex. RxAUTH: efficient prior authorization (PA) management service that automates the PA process for clients.  Maintain a high level of consistency and integrity to interpret a variety of instructions in order to program them and work with management to operationalize them. Also communicate those instructions to a group or individual PA specialist.  Attend regular meetings as a forum to effectively communicate progress and QA feedback to management, and bring up any issues, concerns or give any other updates.  Use knowledge of quality control, Pharmacy Benefit Management, and Health Insurance Industry to provide excellent customer service, maintain all updates, changes to requirement schedules, PA details, and GPI lists per client request. Alexian Brothers Behavioral Health Hospital Hoffman Estates, IL Physician Health Record Controller, 2014  Diligently trained in new CPOE quality improvement module, successfully transcending minimal standards.  Taught doctors to enter labs, procedures, nursing interventions, diets, customizing module, medications, eliminating duplicate orders, potential for discharge, and sign orders.  Quickly resolve physician issues and concerns to effectively implement patient care.  Create reports trending physician activities and disputes within departments in order to direct resolution.  Lead and coordinated team to effectively cover hospital rounds while promoting cooperation. WellCare Health Plans, Inc Chicago, IL Quality Improvement Specialist, 2013  Collaborate with hospital and health care staff to properly request and transferred medical records to complete the Healthcare Effectiveness Data and Information Set (HEDIS) quality assessment review.  Carefully conducted and recorded 81 quality measure requirements for HEDIS pertaining to Effectiveness of Care, Access/Availability of Care, Experience of Care, and Health Plan Descriptive Information.  Cross-reference multiple software such as XCELYS 6.1 that executes several extended business functions which increases quality and benefits for health plan administration. Along with EMMA 2.5 that maintains accurate records of case management activities, in order to research patient, doctor, and claim information.  Completed HIPAA Compliance for Health Plans 2013, training that portability and continuity of health insurance. St. Alexius Medical Center Hoffman Estates, IL Physician Health Record Controller, 2012  Quickly understood new EHR software after a week of training.  Tutor physicians how to effectively use software, such as: rounding list, build cover, current/past visits, vital signs, medications, and order test. Golf Maine Park District Niles, IL Commissioner, 2016  Hire and train director. Set goals, formulate policies, and establish

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    из 2

    RICARDO VAUGHAN

    CONTACT
    8928 W. Church St Des Plaines IL, 60016
    rvaughan3@gmail.com (847) 409-2705
    EDUCATION
    University of Illinois at Urbana-Champaign
    Bachelor of Science in Health Planning and Administration, May 2011
    Calculus III, Acc. Chemistry II, Health Care Systems, Health Services Financing, Health
    Administration, Advanced Topics in Communication, Public Speaking
    WORK EXPERIENCE
    Optum Schaumburg, IL
    Industry Relations Specialist, 2016
    Manage pharmacy MAC pricing reviews. Diligently uphold review standards in the appeal
    process and quality assurance, disregarding inadequate reviews. Examine purchase price
    of drugs, NDC, compounds, Rx no., NCPDP, BIN, PCN, and Filled Date
    Create MAC reports, pharmacy fax responses, research appeal history and origin in
    various databases, run queries for appeal resolution, maintain information security
    operations.
    Work with team to discuss client preferences, new state laws, collaborate with Rx
    Reimbursement Team
    Catamaran Schaumburg, IL
    Clinical Operations Specialist, 2015
    Responsible to work independently or cooperatively with team members to create,
    program, set up and maintain pharmacy benefit applications, ex. RxAUTH: efficient prior
    authorization (PA) management service that automates the PA process for clients.
    Maintain a high level of consistency and integrity to interpret a variety of instructions in
    order to program them and work with management to operationalize them. Also
    communicate those instructions to a group or individual PA specialist.
    Attend regular meetings as a forum to effectively communicate progress and QA feedback
    to management, and bring up any issues, concerns or give any other updates.
    Use knowledge of quality control, Pharmacy Benefit Management, and Health Insurance
    Industry to provide excellent customer service, maintain all updates, changes to
    requirement schedules, PA details, and GPI lists per client request.
    Alexian Brothers Behavioral Health Hospital Hoffman Estates, IL
    Physician Health Record Controller, 2014
    Diligently trained in new CPOE quality improvement module, successfully transcending
    minimal standards.
    Taught doctors to enter labs, procedures, nursing interventions, diets, customizing module,
    medications, eliminating duplicate orders, potential for discharge, and sign orders.
    Quickly resolve physician issues and concerns to effectively implement patient care.

    Create reports trending physician activities and disputes within departments in order to
    direct resolution.
    Lead and coordinated team to effectively cover hospital rounds while promoting
    cooperation.
    WellCare Health Plans, Inc Chicago, IL
    Quality Improvement Specialist, 2013
    Collaborate with hospital and health care staff to properly request and transferred medical
    records to complete the Healthcare Effectiveness Data and Information Set (HEDIS) quality
    assessment review.
    Carefully conducted and recorded 81 quality measure requirements for HEDIS pertaining to
    Effectiveness of Care, Access/Availability of Care, Experience of Care, and Health Plan
    Descriptive Information.
    Cross-reference multiple software such as XCELYS 6.1 that executes several extended
    business functions which increases quality and benefits for health plan administration.
    Along with EMMA 2.5 that maintains accurate records of case management activities, in
    order to research patient, doctor, and claim information.
    Completed HIPAA Compliance for Health Plans 2013, training that portability and continuity
    of health insurance.
    St. Alexius Medical Center Hoffman Estates, IL
    Physician Health Record Controller, 2012
    Quickly understood new EHR software after a week of training.
    Tutor physicians how to effectively use software, such as: rounding list, build cover,
    current/past visits, vital signs, medications, and order test.
    Golf Maine Park District Niles, IL
    Commissioner, 2016
    Hire and train director. Set goals, formulate policies, and establish services for the district
    that will meet the needs of citizens.
    Focus organization on key initiatives. Derive financial insights. Strategize for well-structured
    5 year budget.
    ACTIVITIES/ SKILLS
    Computer Software
    Microsoft Office, Meditech 6.0, AlexiCARE 6.0 Physician Care Manager, Rumba AS/400
    Midas+ Care Management, ServiceNow IT Service Automation applications, XCELYS 6.1,
    EMMA 2.5
    Certification
    Registered Illinois Pharmacy Technician, License # 049.213138
    Volunteering
    Habitat for Humanity, Basketball coach, Volleyball coach.
    Capital
    Owner and CEO of online business

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