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Clinical Review Technician Resume Example

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CLINICAL REVIEW TECHNICIAN
Professional Summary
Biologist with background in food safety and healthcare seeking an entry level healthcare position with opportunities for professional growth.
Skills
  • Effective workflow management
  • Microsoft Outlook, Word and Excel
  • Effective problem solver
  • Excellent time management skills
  • Attention to detail
  • Quick learner
  • Exceptional interpersonal communication
  • Skilled trainer
  • Trained in HIPPA compliance
Work History
September 2015-CurrentClinical Review Technician | Company Name | City, State
    Reviewing and processing Prior Authorization requests for Blue Cross Blue Shield members. Processing claims for different Utilization Management programs including Step Therapy, Quantity Exceptions, Formulary Exceptions and specific client reviews. Applying a working knowledge of Clinical Review Engine and RxCLAIM systems with additional databases and resources to determine the final outcome of clinical review requests. Analyzing review criteria, following process flow and conducting outreach to ensure compliance with Clinical Review standards.Promoted to Mentor of the Clinical Review Technician team to assist in answering questions and problem solving with the processes.
  • Effectively resolved insurance rejections and other billing issues.
  • Determined prior authorizations for medication and outpatient procedures.


August 2013-May 2015Student Manager | Company Name | City, State
    Provide leadership and strong communication skills for the student workers in the college cafeteria during food service hours. Ensured quality of the food and a healthy and safety of the work area for workers and customers. Trained in new employees and seasoned employees on new positions and skills needed to provide excellent service to customers.
  • Ensured freshness of food and ingredients by checking for quality, keeping track of old and new items, and rotating stock
  • Inspected and cleaned food preparation areas to ensure safe and sanitary food-handling practices
  • Solved unresolved customer issues.
  • Managed work flow to exceed quality service goals.
  • Cross-trained and backed up other customer service workers.


Education
2015Bachelor of Science: BiologyWinona State University, City, State
Accomplishments
A year of Capstone studying with the Dean of Biology supervising to present my work at the Mississippi River Research Consortium.
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Resume Overview

School Attended

  • Winona State University

Job Titles Held:

  • Clinical Review Technician
  • Student Manager

Degrees

  • Bachelor of Science : Biology

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