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lead prior authorization specialist resume example with 11+ years of experience

Jessica
Claire
resumesample@example.com
(555) 432-1000,
, , 100 Montgomery St. 10th Floor
:
Professional Summary

Accomplished and certified Pharmacy Technician with over 10 years of experience in retail pharmacy environments for major national chains. Practiced at offering medications to patients, offering information to patients and communicating with healthcare professionals. Knowledgeable about FDA drug safety guidelines, prescription interactions and pharmacy law. Also, a hardworking Prior Authorization Specialist with successful background working closely with insurance company representatives to gain approval for infusion and injection procedures and prescription medication authorizations. Detail-oriented performer with years of managing documentation. Considered team player with notable multitasking and prioritizing skills.

Skills
  • EPIC
  • Retro-Authorizations
  • Understanding of insurance details
  • Prescription Coordination
  • Authorizations
  • Written Communication
  • Allina Health A3 Project(s) - Retail Pharmacy PA Hub's: Improve Retail Pharm Med Prior Auth Process and Centralized Business Team: Improve Quality Process
  • Responsive
  • Detail-oriented
  • Respectful of other's time
Education
Champlin Park High School Champlin, MN Expected in 06/2009 High School Diploma : - GPA :
Work History
Francisan Health - Lead Prior Authorization Specialist
Schererville, IN, 11/2020 - Current
  • Mentored new hires, resulting in stronger staff development and increased productivity.
  • Eliminated process gaps by implementing new methods of standardized training. Participated in two A3 department projects to improve workflow processes.
  • Tracked staff progress in productivity measures and adapted plans to maintain progress.
  • Reached out to insurance carriers to obtain prior authorization for prescription medications and infusion and injection procedures.
  • Documented and routed denial letters, detailing reasons for denial and possible appeal measures.
  • Collaborated with other Leads from the Centralized Business Team to improve process correlating with staff quality measures.
  • Created and maintained department workflow resources.
  • Created and maintained spreadsheets detailing most common Pharmacy Benefit Manager's medication criteria, contact information, and special considerations.
  • Responsible for staff scheduling, such as cross-coverage for unscheduled and scheduled time-off requests.
  • Addressed and communicated areas of opportunities with department and clinic staff.
  • Maintained energy and enthusiasm in fast-paced environment
  • Participated in continuous improvement by generating suggestions, engaging in problem-solving activities to support teamwork
  • Prepared a variety of different written communications, reports and documents to ensure smooth operations
  • Improved operations through consistent hard work and dedication
  • Developed and implemented performance improvement strategies and plans to promote continuous improvement
  • Developed team communications and information for meetings
  • Monitored all medication and supply inventory to ensure stock levels and databases were updated
  • Used coordination and planning skills to achieve results according to schedule
  • Delivered outpatient discharge medications to hospital floor locations within specific timeframes
  • Created spreadsheets using Microsoft Excel for daily, weekly and monthly reporting
  • Managed team of 8 employees, overseeing hiring, training, and professional growth of employees
  • DeClaireted special emphasis to punctuality and worked to maintain outstanding attendance record, consistently arriving to work ready to start immediately
Reid Hospital & Health Care Services - Prior Authorization Specialist
Richmond, IN, 11/2018 - 10/2020
  • Input all patient data regarding claims and prior authorizations into system accurately.
  • Reached out to insurance carriers to obtain prior authorization for prescription medications.
  • Fielded telephone inquiries on authorization details from plan members and medical staff.
  • Documented denial letters, detailing reasons for denial and possible appeal measures.
  • Communicated with leadership about consistent workflow issues.
  • Presented clear and concise explanations of governing rules and regulations.
  • Gathered records pertinent to specific medication and diagnosis, reviewed for completeness and accuracy and attached records to correspondence as necessary.
Allina Health - Pharmacy Technician
City, STATE, 07/2015 - 07/2018
  • Communicated with patients to collect information about prescriptions and medical conditions or arrange consultations with pharmacists.
  • Consulted with insurance company representatives to complete claims processing, resolve concerns and reconcile payments.
  • Maintained proper drug storage procedures, registries, and records for controlled drugs.
  • Entered and processed patients' prescriptions into internal system.
  • Calculated dosage, filled prescriptions and prepared prescription labels with absolute accuracy.
  • Counted, measured, and compounded medications following standard procedures.
  • Assisted pharmacist by filling prescriptions for customers and responding to patient questions regarding prescription and medication-specific issues.
  • Resolved non-routine issues like third party billing, computer system and customer service issues.
  • Counted and labeled prescriptions with correct item and quantity.
  • Verified patient data and billing information to discover and resolve erroneous bills due to system errors.
Target Pharmacy - Pharmacy Team Lead & Technician
City, STATE, 06/2009 - 07/2016
  • .Coached team members in techniques necessary to complete job tasks.
  • Worked different stations to provide optimal coverage and meet production goals.
  • Evaluated employee skills and knowledge regularly, training and mentoring individuals with lagging skills.
  • Trained new team members by relaying information on company procedures and safety requirements.
  • Developed monthly and daily production output plans to deliver on customer service and financial metrics.
  • Minimized resource and time losses by addressing employee or production issue directly and implementing timely solutions.
  • Managed schedules, accepted time off requests and found coverage for short shifts.
  • Took on additional job duties during unexpected backlog, resulting in meeting project target date.
  • Verified safety and efficacy of medication usage by reporting adverse drug effects, medication errors and other quality issues.
  • Interpreted prescription orders, dispensed medications and referred patients to the pharmacist for medication consultations.
  • Checked medication bottles for proper labeling before allocating to patients.
  • Stayed current with third-party payer policies and procedures to prevent payment issues.
  • Complied with strict health, industry and organizational regulations to maintain patient safety.
  • Collaborated with colleagues, technicians and leading pharmacists in effective prioritization and filling of orders.
  • Inspected drug storage sites, monitored drug supply expiration dates and verified proper supply levels
Additional Information
  • Currently attending Minneapolis Community & Technical College to obtain my Associates in Biology of Science and hope to transfer to Augsburg to complete their Physician Assistant program.
  • Currently attending an Agile Project Management certification class at the University of St. Thomas.

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Resume Overview

School Attended

  • Champlin Park High School

Job Titles Held:

  • Lead Prior Authorization Specialist
  • Prior Authorization Specialist
  • Pharmacy Technician
  • Pharmacy Team Lead & Technician

Degrees

  • High School Diploma

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