Aarti Malian Rahman
Tamarac,USA
Summary
Experienced pharmacy auditing professional with expertise in regulatory compliance, medication safety, and risk management. Demonstrated ability to work collaboratively within teams to ensure accuracy and uphold audit standards. Skilled in detecting discrepancies, enhancing operational efficiency, and adjusting to evolving regulations. Dependable and goal-oriented professional committed to optimizing pharmacy operations.
Overview
21
21
years of professional experience
1
1
Certification
Work History
Pharmacy Auditor II
MedImpact
07.2023 - Current
- Prepares and completes desktop and onsite audits, including obtaining claim data for selection analysis, reviewing dispensing activities for billing errors, reviewing federal/state/local pharmacy laws, documenting audits results, and notifying pharmacies.
- Partner with other business units to effectively resolve customer issues and inquiries.
- Audit multiple Pharmacy settings such as, Retail, Long Term Care, Specialty and Compounding.
- Collaborated with pharmacists to ensure proper adherence to regulatory guidelines, maintaining a high level of patient safety and care.
- Maintains up-to-date knowledge on industry regulations and best practices for continual enhancement of the auditing process.
- Supports company growth by identifying areas for potential new business opportunities during routine audits.
- Reduced financial losses with proactive identification of overpayments, underpayments, and unauthorized transactions.
- Identified fraudulent activities by thoroughly analyzing prescription claim data and investigating discrepancies.
Claim Auditor- FWA/Compliance
Elixir
10.2015 - 07.2023
- Analyze original prescriptions and other pharmacy related documentation to identify waste/billing errors
- Perform mathematical comparisons and analysis to verify prescription claims accuracy and validity
- Audit different pharmacy settings such as, Retail, LTC, Specialty and Compounding Pharmacies
- Assist with research, assembly, and completion of various reporting documents for clients, Centers for Medicare and Medicaid Services, and internal use(PDE Audits)
- Analyzing and identifying trends of onsite audit pharmacy data
- Quality check of onsite audit documentation and recovery files for accounting
- Develop and report department audit results
- Prepare invoice file for audits performed as assigned and complete within deadline
- Compile documentation in relation to investigations of pharmacies, members, and prescribers as it relates to departmental activities
- Audit Creation for clients within specified time frames
- Train junior staff in new department procedures
- Develop and maintain working relationships with corporate clients
- Provided detailed documentation on audit findings, facilitating swift corrective action when necessary.
- Maintained confidentiality, handling sensitive information discreetly throughout all stages of the audit process.
- Ensured compliance with regulatory requirements by performing regular audits and staying up-to-date on industry standards.
- Streamlined audit processes, improving efficiency and reducing time spent on each audit engagement.
- Developed strong relationships with clients, building trust and ensuring a high level of satisfaction during the audit process.
- Mentored junior auditors, sharing knowledge and best practices to foster their professional growth within the team.
- Followed established auditing processes to meet internal and regulatory requirements.
- Planned and executed follow-up audits at appropriate intervals.
- Increased internal control effectiveness through diligent evaluation of processes and providing recommendations for improvement.
Pharmacy Technician Team Lead/Adjudication/QC
Kare Pharmacy
04.2014 - 10.2015
- Training new hires and co-workers with insurance verification, interpreting and solving insurance rejections which includes working with Medicaid, HMOs, Part D plans and commercial insurances.
- Finding and verifying the correct insurance information for patients
- Processing claims, contacting insurance companies to resolve claim rejections.
- Contacting customers at times to obtain insurance information
- Working with the IT department to test the new adjudication system and assisting with solutions for process improvement.
- Quality control on leads coming in from call center
- Lead Distribution
Pharmacy Billing/Census
Rxperts Pharmacy
03.2009 - 04.2014
- Updating Daily Census for Long Term Care facilities utilizing Framework/Docutrack
- Checking Admissions for correct pay types/Correcting Payor Types
- Updating discharges/per diem dates
- Responsible for updating Hospice Profiles, rebilling adjudicated and non-adjudicated hospice.
- Assisting with billing related phone calls- Facilities, Insurance Companies.
- Assisting data entry technicians with issues/questions in regards to admissions, discharges, insurance.
- Updating patient demographics, checking admission paperwork for accurate information
- Verifying insurance coverage.
- Solving billing rejections- Medicaid, Medicare Part D, Commercial Insurances
- End of month billing- Requesting facility summaries, solving discrepancies by working with the facilities and daily census to resolve end of month billing issues
Pharmacy Coordinator
AOM Pharmacy
12.2004 - 01.2009
- Communicating with patients, caretakers, authorized third parties and doctors as needed.
- Data entry of Respiratory, Diabetic and Medicare D reorders into QS1
- Received and made outgoing calls to all patients on refilling their medications, correcting insurance issues, shipping inquiries.
- Adept at reading and interpreting prescription terminology and medications.
- Posting payments and credits, charging credit cards through plug and pay system.
- Medical Records- Posting, Pulling and Filing of Prescriptions.
- Processing claims through all the various Pharmacy Benefit Managers.
Pharmacy Technician
Walgreens Pharmacy
06.2004 - 11.2004
- Processed new prescription orders and also took reorders over the phone.
- Assisted with the drive through, customer service, cashier.
- Internship
Education
Pharmacy Technician
Mcfatter Technical School
Davie, FL05.2004
High School Diploma - undefined
Flanagan High School
Pembroke Pines, FL06.2002
Skills
- Skilled in Microsoft Office applications
- Great organizational skills and time management
- HIPAA compliance
- Pharmacy operations
- Task prioritization
- Team building
- Critical thinking and analysis
- Documentation and reports
- Adaptability and flexibility
- Audit programs and processes
- Data analytics
- Client relationship management
- Decision-making
Certification
Nationally Certified Pharmacy Technician- CpHT
Pharmacy Technician License- FL
Currently working on Google Data Analytics Certification April 2025- Present
Timeline
Pharmacy Auditor II
MedImpact
07.2023 - Current
Claim Auditor- FWA/Compliance
Elixir
10.2015 - 07.2023
Pharmacy Technician Team Lead/Adjudication/QC
Kare Pharmacy
04.2014 - 10.2015
Pharmacy Billing/Census
Rxperts Pharmacy
03.2009 - 04.2014
Pharmacy Coordinator
AOM Pharmacy
12.2004 - 01.2009
Pharmacy Technician
Walgreens Pharmacy
06.2004 - 11.2004
High School Diploma - undefined
Flanagan High School
Pharmacy Technician
Mcfatter Technical School
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