Ashley Brickett
Strategic Programs
Strategic and results-driven business and data analysis with 19 years of experience in margin management, contract management, and business operations related to pharmaceutical industry. Recognized as a creative thinker with strong analytical skills proficient at conceptualizing efficient solutions that align with business strategy. Talented at translating and simplifying complex systems so that they are understandable. Equipped with excellent communication skills, work ethics, and possesses a strong sense of leadership with a commendable record of accomplishment.
ashley.brickett@gmail.com 480-358-8558
Midlothian, TX brickettva.com
Skills and Competencies
Data Gathering & Analysis Financial Reporting Margin Management Reporting
Communication Strategies Business Process Improvement Impact Analysis Reporting
Clinical & Analytical Thinking Statistical Method & Techniques Quantitative & Qualitative Research
Contract Management & Negotiation Contract Database Strategic & Business Planning
Work Experience
Managed Care/Strategic Program Consultant
Optum Specialty Pharmacy
2018 – Current
Payer performance analytic reporting
Partnered with the pricing team on contractual related projects to ensure that the margin was not impacted by contractual obligations
Managed direct and indirect remuneration accrual reporting, margin analysis, and contract impact analysis reporting
Created and managed database to track year over year DIR contracts related to fees.
Created and managed quarterly contract database which includes all third-party contracts tied to processing information, plan, reimbursement rates, and contracting status by pharmacy.
Create reporting analysis to project, analyze and manage direct and indirect remuneration fees within third-party contracts.
Managed Care Contracting Manager
Avella Specialty Pharmacy
2015-2018
Overseen the margin as it related to third-party payers.
Managed all insurance contracts. Including Created impact analysis reporting for executive team. Lead the company to proactively manage direct and indirect remuneration fees.
Transitioned the entire specialty pharmacy from a pharmacy provider network which allowed access to insurance contracts to direct independent contracts. This includes commercial, Medicaid, Medicare D and managed care contracts for medical and pharmacy benefits.
Created a streamline system to manage DIR (direct and indirect remuneration) fees so that the pharmacy could properly allocate the fees due as well as assess the true margin once fees were applied.
Managed all NCPDP and NPI for all 20 pharmacies
Managed the integration of more than five pharmacy acquisitions to onboard the pharmacy into the Avella pharmacy insurance contracts as well as Medicare and Medicaid to ensure no lapse in coverage.
Managed all Pharmacy Benefit Manager relationships and contracts
Managed all Medicare Part B contracts including audits and Accreditation's
Managed all specialty pharmacy contract accreditation processes to ensure that Avella Specialty Pharmacy would be included in the specialty closed network.
Created a system to monthly and quarterly review claims were adjudicating at the appropriate contractual rate. Including a process to evaluate any claims that were not paid to contract. This would save the pharmacy a significant amount of money month over month.
Created a system to monitor all claims that the pharmacy was not able to process and resulted in a transfer out of Avella. If due to a insurance contractual issue a process was set up to attempt to retrieve access to the contract.
Created a review process for all pharmacy and medical insurance contracts which included a database, margin impact analysis, pharmacy operations obligations, reporting requirements, and general contractual language that the pharmacy would be liable for. This process was essential to the executive leadership of Avella as they would review this analysis along with the legal team before the contract could be executed. This included all insurance contracts such as commercial, managed care, Medicare B and D, Medicaid, and discount card.
As the managed care manager, I was responsible for any issues that involved an insurance contract, claim processing issue, switching issue, Medicare, and Medicaid.
Prepared information for the Executive VP to present at board meetings regarding insurance contracts, claim issues, legal issues related to Medicare/Medicaid as well as the accrual of DIR fees
Created operational systems to account for contractual obligations that were simple incorporate into the daily pharmacy operating system using the adjudication process.
Consulted pharmacy operations to effectively manage claims according to contractual guidelines.
Worked with marketing team to ensure contractual access in target areas. Created a sharable database that the marketing team was able to obtain real time eligibility of payers as well as maps of covered areas.
Partnered with clinical and quality assurance to ensure pharmacy met performance standards were met and all information was obtained.
Worked closely with revenue cycle management team to provide support on claim processing issues, service areas to assist in claims adjudicated but not reimbursed to the pharmacy for a multitude of reasons. As well as assisting in claim transmission, ensure compliance with remittance files, and generate usable reporting.
In 2017 honored to be awarded with the highest achievement award the company offered as well as the strategic programs impact award for my dedication and innovation to manage and create the highest level of service within the resources provided.
Business Transition Operations
Pharmacy Concepts
2014 – 2015
Managed the transition of hand filling prescription punch cards to machine filling for a nursing home pharmacy.
Created a training program for the nursing home staff to transition from punch cards to prefilled medication packets.
Held in person training programs for nursing staff and pharmacy staff.
Traveled to nursing homes to perform audits on the system.
Assisted in billing of claims for the new automated system of machine filled prescriptions.
Eligibility Specialist
Express-Scripts
2012-2014
Responsible for the highest-level eligibility cases to ensure that claims and patients had insurance eligibility before the claim could be billed and the medication could be shipped.
Determined benefits for specific medications based on coverage.
Managed prior authorizations for medications that required before eligible for reimbursement
Responsible for ensuring that the coverage was obtained timely so that patient received medication timely or if there was an issue that delayed the shipment the patient would be timely notified, and the situation would be accurately explained to the patient.
Navigated multiple orders and insurance issues at one time effectively
Knowledgeable in pharmacy and medical benefit structures of all plan types such as Medicare, Medicaid and commercial plans.
Managed Care – Third Party Administrator
Avella Specialty Pharmacy
2004 – 2012
Created and managed Specialty drug coverage eligibility verification and tracking process related to pharmacy benefits and medical benefits. System created included an electronic ticket being submitted, worked by a technician in the Managed Care department, then communicated back to the pharmacy operations staff to properly be adjudicated so that the claim would be reimbursed properly by payor.
Targeted communication, education and training for Managed Care staff and Pharmacy operations staff to understand the reimbursement process for specific payer types and coverage categories. Such as Medicare Part B verse Medicare Part D covered medications, determining if the patient had crossover coverage and how to properly bill the claim to ensure accurate reimbursement.
Managed relationship between pharmacy operations, managed care department, IT, clinical and the switching service to Improve outcomes and support for pharmacy operations to ensure that automated notifications would populate prior to adjudicating a claim to ensure that all requirements were met before claim dispensed.
Created a comprehensive reporting system to demonstrate to accounting and executive staff the claims that were paid by both primary and secondary payers
Point of contact for pharmacy software system support and pharmacy operations. All pharmacy software issues related to claims processing were reported directly to me to resolve. Created a reporting and tracking mechanism.
Education
Bachelor of Biology
University of Texas
Certificates & Trainings
Trained Pharmacy Technician Certified by Pharmacy Technician Certification Board
Technical Skills
NCPDP – National Council for Prescription Drug Programs NPPES – National Plan and Provider Identifier
Medicare/Medicare Contracting Pharmacy Benefit Management Switch & Clearing House
Revenue Cycle Management Margin Management
Contract Analysis
Honor Awards
Strategic Programs Impact Award (2017) Beatrice Swygert Employee of the year Award (2017)
Avella Avella
Conservative Leadership Award (2021)
Texas Score Card
Volunteer & Personal Projects
Volunteer @ Project Gabriel Ministry
Founder of Respect Midlothian a Parents Educational Coalition for school aged children