JULIE SCHATZEL
Quincy
Overview
10
10
years of professional experience
Work History
Contract Development Analyst
Blue Cross Blue Shield Of Massachusetts
04.2018 - Current
- Assess requirements for annual DOI filings for the Merged Market, Qualified Health Plans (QHPs), and Qualified Dental Plans (QDPs).
- Manage the federal Health Information Oversight System (HIOS) filing process on behalf of BCBSMA.
- Identify changes in the filing requirements, key deliverable dates, and impacted business areas.
- Assemble implementation team participants and facilitate implementation meetings (set up meetings, create agendas, issue minutes).
- Document identified issues and ensure resolution.
- Develop corporate filing approach to submit to required regulatory agencies accurately and on time.
- Support the development of new and revised policy forms and contracts for all product lines and financial arrangements by proof‑reading and reviewing documents and drafting new routine, non-complex riders.
- Actively support the sales and service processes and workflows by analyzing nonstandard benefit requests and providing thorough, accurate, and timely responses.
Pharmacy Analyst
Blue Cross Blue Shield Of Massachusetts
09.2015 - 04.2018
- Utilize ESI’s Client Website and BCBSMA’s Secure File Transfer Website to obtain Rejected Claims, Mail Order Consent, and Transition Supply reports daily and Hospice and ESRD Paid Claims reports weekly.
- Review denied Medicare Part D pharmacy claims to ensure denials are appropriate by researching member effective date, formulary status of the drug, and quantity limits.
- Ensure Medicare Part B pharmacy claims appropriately apply to member’s out-of-pocket maximum.
- Validate copay proration calculations as required by CMS for claims with a day’s supply less than 30.
- Review claims denied for drugs that could be covered under Medicare Part B or Part D. Review account to see when Prior Authorization has been posted and verify member was able to fill prescription.
Member Service Associate
Blue Cross Blue Shield Of Massachusetts
07.2013 - 08.2015
- Possess strong verbal and written communication skills by consistently connecting with members, peers, and leaders
- Ability to work effectively in an organized and fast paced environment by utilizing time management and prioritizing tasks
- Assist Member Service Research with a variety of member inquires while ensuring a high level of service and resolution in a timely manner
- Educate members about different plans at benefit fairs while assisting sales
- Learned and maintained in-depth understanding of product and service information to offer knowledgeable and educated responses to diverse customer questions.
Education
Master of Science -
State University of New York At New Paltz
New York2012
Skills
- Verbal and Written Communication
- Planning and Prioritization
- Critical Thinking
- Professional Relationship-Building
Blue Cross Blue Shield System Knowledge
AMS, SERFF, BARS, Product Master, BlueData, HIOS, Teamsite
Computer System Knowledge
Excel, Word, Microsoft Outlook, PowerPoint, Mac based systems
Timeline
Contract Development Analyst
Blue Cross Blue Shield Of Massachusetts
04.2018 - Current
Pharmacy Analyst
Blue Cross Blue Shield Of Massachusetts
09.2015 - 04.2018
Member Service Associate
Blue Cross Blue Shield Of Massachusetts
07.2013 - 08.2015
Master of Science -
State University of New York At New Paltz
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