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Zandra Calio

Chadron State College
From Munhall, PA
Payer Resolution Specialist at Walgreens
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Payer Resolution Specialist/Analyst at Walgreens
Liaison between Operation, and Implementation teams. Collaborates with the Technical, Reimbursement, Finance, Provider Enrollment and Contracting teams. Responsible for reviewing plan set up and functional requirements to implement into the ScriptMed operating system. Accountable for analyzing no-go referrals and provides daily/monthly statistics to management. Identify options, issues, and provide recommendations to address problems in current member retention with medical/pharmacy benefit that can be filled at a WSP facility, retail, and home infusion centers. Identify patterns of user errors and trends, and escalate issues to the next level of management. Implement and maintain client requests for formulary channeling/NDC not covered and split fill cycle management programs. Web administration for WSP employees to enroll, maintain and retrieve passwords for payer/client web sites. Create and maintain Client Profile Worksheets and SOP's for pay plans. Interface with internal and external clients to test system functionality for obtaining software vendor certifications and to test ScriptMed system upgrades. Maintain WSP Medicare/Medicaid provider listing and coordinate with WAG Provider Enrollment department on new/renewal Medicaid and Medicare enrollments.
November 2012 - Present
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