Robert Travis Sparks
Nashville
Summary
Seeking a challenging and rewarding position as a Fraud Specialist that will allow me to utilize my job skills and knowledge while providing opportunity for continuing education and growth in a challenging environment.
Overview
21
21
years of professional experience
1
1
Certification
Work History
Manager of Operations
Rams Pharmacy
02.2018 - Current
- Developed a strong team through effective recruitment, training, and performance management strategies.
- Ensured compliance with federal, state, and local regulations by maintaining up-to-date knowledge of pharmacy laws and guidelines.
- Addressed customer complaints or issues in a timely manner, demonstrating empathy and commitment to exceptional service standards.
- Fostered a positive work environment by addressing staff concerns promptly and fairly.
- Collaborated with other pharmacy managers within the organization to share best practices and identify opportunities for improvement across locations.
- Managed pharmacy inventory for optimal product availability and reduced waste.
- Maximized employee productivity through effective scheduling, delegation of tasks, and ongoing feedback on performance goals.
- Enhanced patient care by providing personalized medication recommendations based on individual needs and preferences.
- Initiated community outreach efforts such as health fairs or educational seminars to promote awareness of pharmacy services available at the retail location.
- Strengthened relationships with healthcare providers to facilitate seamless communication regarding patient medications and therapies.
- Boosted store profitability through strategic pricing adjustments and cost-control measures.
- Educated patients about proper medication storage, disposal, and safety practices to minimize potential risks or adverse effects.
- Coordinated with healthcare professionals to ensure accurate medication therapy and improved patient outcomes.
- Increased customer satisfaction by implementing efficient prescription processing and medication counseling.
- Implemented innovative marketing strategies to attract new customers and increase sales revenue.
Fraud Investigator
Catamaran Rx
09.2013 - 02.2018
- Maintaining relationship with clients in reference to FWA
- Proactive Fraud Investigations
- Proactive Data Mining
- Staying up to date on current FWA trends
- Monitoring of HPMS alerts
- Monitoring of MEDIC alerts
- Pharmacy On-site Audits
- Pharmacy Compliance audits
- Invoice audits
- Member and provider outreach in relation to FWA
- Creation of Policy and Procedures related to FWA
Fraud Investigator
Cigna-HealthSpring
09.2011 - 09.2013
- Maintaining relationship with PBM in reference to FWA
- Proactive Fraud Investigations in relation to Part-D FWA
- Proactive Data Mining
- Submission of MEDIC referrals
- PBM referrals in relation to FWA
- Staying up to date on current FWA trends in regards to FWA
- Customer Service referrals in relation to Part-D FWA
- Monitoring of MEDIC alerts
- Monitoring of HPMS alerts
- The audit process for Cigna-HealthSpring’s outside audit company, Xerox (100%)
- Maintaining financials with Xerox (Invoices)
- Targeted FWA on-site audits
- The collection process with Catamaran in relation to Audit recoveries
- Invoice Audits with network pharmacies
- Member outreach, and also provider outreach in relation to FWA
- Maintaining all records in relation to Audit Process, and also FWA Process
- The creation of policies and procedures and standard operating procedures related to the FWA and audit process
Pharmacy Specialist II
HealthSpring
07.2010 - 09.2011
- The entry and processing of member coverage determinations
- The entry and processing of direct member reimbursements (DMR)
- Contacting members/providers/Power of Attorneys to advise of the decision made regarding coverage determination(s)
- Contacting providers/pharmacies/members to obtain information to adequately process coverage determinations and Direct Member Reimbursements
- Reviewing authorization reports to ensure all authorizations (overrides) are entered into SXC accurately
- Correcting authorizations (overrides) in SXC if errors are found while reviewing the authorization report
Pharmacy Specialist II
Maxim Staffing Solution (HealthSpring)
03.2010 - 07.2010
- The entry and processing of member coverage determinations
- The entry and processing of direct member reimbursements (DMR)
- Contacting members/providers/Power of Attorneys to advise of the decision made regarding their coverage determination(s)
- Contacting physicians’/pharmacies/members to obtain information to adequately process coverage determinations and Direct Member Reimbursements
- Reviewing authorization reports to ensure all authorizations (overrides) are entered into SXC accurately
- Correcting authorizations (overrides) in SXC if errors are found while reviewing the authorization report
Senior Certified Pharmacy Technician
Kroger Pharmacy
12.2003 - 01.2010
- Supervision of other Pharmacy Technicians within the pharmacy
- Workflow of the Pharmacy
- Scheduling of staff (Pharmacy Technicians)
- Scheduling of vacation for staff
- Auditing prescriptions dispensed to determine any discrepancies between the data entered into the system and details listed on the prescription
- Filling prescriptions with pharmacist supervision
- Administrative work within the pharmacy
- Billing claims to insurance companies for payment on dispensed medications
- Operating under the supervision of a pharmacist to perform data entry, patient/provider review, and resolution of third-party exceptions
- Operating under the supervision of a pharmacist to deliver quality patient care, and excellent customer service
Education
Criminal Justice - Criminal Justice
Nashville State Community College
Nashville02.2016
Associates of Science Degree - Pre-Pharmacy
Volunteer State Community College
01.2013
Skills
- Excellent communication skills
- Proficient in Microsoft Word
- Proficient in Microsoft Excel
- Proficient in Microsoft Outlook
- Proficient in Microsoft PowerPoint
- Proficient in RXClaim
- Proficient in Argus
- Proficient in MHC
- Proficient in Sanovia
- Proficient in Marx
- Fraud identification skills related to Medicare Part-D
- Excellent investigative skills
- Patient education and counseling
- Prescription verification
- Workflow optimization
- Pharmacy operations management
- Drug inventory management
- Regulatory compliance
- Training and mentoring
- Staff training
- Inventory control
- Inventory and restocking
- Patient counseling
- Employee management
- Direct patient care
- Drug safety
- Staff management
Certification
- Certified Pharmacy Technician, 03/01/06
- Blood Sugar Testing Certified, 12/01/05
- NADDI (National Association of Drug Diversion Investigators) member, 11/01/12
Timeline
Manager of Operations
Rams Pharmacy
02.2018 - Current
Fraud Investigator
Catamaran Rx
09.2013 - 02.2018
Fraud Investigator
Cigna-HealthSpring
09.2011 - 09.2013
Pharmacy Specialist II
HealthSpring
07.2010 - 09.2011
Pharmacy Specialist II
Maxim Staffing Solution (HealthSpring)
03.2010 - 07.2010
Senior Certified Pharmacy Technician
Kroger Pharmacy
12.2003 - 01.2010
Associates of Science Degree - Pre-Pharmacy
Volunteer State Community College
Criminal Justice - Criminal Justice
Nashville State Community College
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