Speaker: Edwin Capetillo, Senior Director, Pharmacy Operations
Tell us about you.
Edwin Capetillo: Hey, right way. Uh For those who don't know me, I'm me Capito and I'm part of the PB M operations team. I oversee our contact center uh who work on the front line every day to support our members, pharmacies and providers navigate, pharmacy benefits our PB M data operations team who work with carriers and TPAS to establish connectivity and business requirements for files such as eligibility accumulators and claim extras and our PB M benefit configuration team uh who manages and updates all of the benefits within tring, which is our claims adjudication platform. I've been with right way close to three years and I'm based out of Philadelphia, Pennsylvania. Uh Why did I join? Right way? I really wanted the opportunity to influence how PB M should support members and clients and felt that right way was best positioned to take on that challenge of transforming the PB M space.
What does implementation season look like for you and your team?
Edwin Capetillo: Implementation season is the busiest time for PB MS. During this time, we are working on gathering requirements on new client implementations, configuring and testing our various systems and training our teams in all of these new requirements. This is done several times over for all new clients. We are on boarding a lot of times. It also dedicated on setting up new connectivity with carers and TPAS. Uh There are a ton of business requirements that need to be accurately captured, developed and tested. Prior to launch, we work very closely with the DN I team to get all these moving parts coordinate as there could be up to several 100 files that need to be established. At the same time, we are working with new clients who are also working on year over year changes for our existing clients. While a lot of focus is placed on new clients, there are many changes we need to account for as our current clients update their benefits for the new calendar year. It's equally important for us to stay focused on these changes to ensure our current members continue to have the best experience going into 2024 all of the work that is being done in Q three and Q four helps for a successful launch to ensure a smooth transition for our clients. So that members are able to walk into the pharmacy come January and have the best member experience.
What are your biggest challenges this implementation season?
Edwin Capetillo: Uh There are several challenges we need to manage going into next year. Uh But I would say the volume increase starting in January is likely our biggest opportunity based on our experience in 2023. Uh we're projecting the volume of interactions to be approximately three times higher in Q one as compared to the remainder of the year to help prepare. There are a few things we're doing uh to help support a new client group. Uh Teams across PB M are hiring for several positions to get ramped up for all the new business. The talent team has been working tirelessly to help PB M screen and recruit for what feels like 1000 candidates. Uh When you have a moment, take a look at the careers page to see what open positions we may have and definitely send in any referrals. Uh We're also bringing on temp support through our partnership with higher G. The temps will be supporting our contact center team and primarily taking on pharmacy help desk calls. Uh This will allow our team to focus on supporting members and providers with the goal of balancing out the distribution of work to manageable levels. Uh based on this additional support, I know we'll be ready to support our new and existing clients for 2024.
