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Experienced Pharmacy Technician/Prior Authorization Coordinator knowledgeable in all facets of pharmacy operations, eager to bring talent and expertise to a Health Care Services organization in the position of PATIENT AUTHORIZATION REPRESENTATIVE/COORDINATOR. Also seeking to advance within a company and take on more responsibilities as I gain necessary knowledge and training.
Licenses In good standing with the Nevada State Board of Pharmacy-Pharmacy Technician PT20461, California State Board of Pharmacy-Pharmacy Technician TCH 81163 and the National Pharmacy Technician Certification Board as a Certified Pharmacy Technician (CPhT) Certification Number 10064132.
Eight years of successful career experience as a retail Pharmacy Technician with major emphasis on direct customer service, obtaining and properly dispensing prescription orders.
Comprehensive academic and clinical experience in terminology, nutrition, pharmaceutical calculations, medication usage and distribution.
Four years of experience in prior authorization reviewing and maintaining expert knowledge on all Medicare Pharmacy benefits and formularies, including Centers for Medicare Services (CMS) regulations as it pertains to this position.
Strong computer skills and working knowledge of Microsoft products, claims processing software with the ability to learn new software applications.
Effective liaison who maintains reliable professional connections between the health care company and its associates. Provide accurate quality checks on active prior authorization claims while working within the guide lines and policies of the company.
Articulate, confident and knowledgeable communications with physicians, medical staff/assistants and insurance/worker compensation agents supported by accurate documentation and time management skills with a professional understanding of Medicare processing and HIPAA guidelines.
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- Analyze and summarize data to support and develop efficient workflow operations.
- Perform wide range of pharmacy operations with strong commitment to accuracy, efficiency and service quality.
- Understand and execute principles of Prior Authorization to facilitate appropriate prescription needs of patients.
- Perform effective communication with Line of Business (LOB) representatives including, but not limited to, Commercial, Medicare and Medi-Cal insurance to verify patients' health plan eligibility.
- Established professional knowledge of DOFR (Division of Financial Responsibility).
- Demonstrated professional knowledge of DOFR (Division of Financial Responsibility).
- Performed Medicare Part D and Commercial HMO/POS Prior Authorizations.
- Assisted members services daily with pharmacy claim issues and inquiries using appropriate references for accurate resolutions.
- Conducted pharmacy claims corrections and performed quality checks on active prior authorization claims when necessary.
- Provided professional assistance to medical offices and pharmacies pertaining to prescription benefit inquiries.
- Reviewed requests made by physicians and pharmacies for use of prescription drugs that are non-formulary and determine appropriate outcome.
- Answered phone calls for prior authorization inquiries.
- Assigned, entered and documented prior authorizations into appropriate claims processing system.
- Provided assistance, support and drugstore management with pharmacists, and conducted continuous professional customer service.
- Daily duties included but not limited to, counting, packaging, labeling and properly dispensing medications.
- Performed follow up calls to physicians, insurance agents and worker compensation claims to verify refills and prescription approvals.
- Obtained and processed medication refill orders by telephone and fax.
- Filled prescriptions, managed supply orders and inventory.
- Referred customers for prescription consultations if required.
- Completed Medi-Cal Treatment Authorization Request (TAR 50-1) forms.
- Strictly maintained customer and patient confidentiality with knowledge in compliance with Health Insurance Privacy and Portability Act (HIPPA) guidelines.
Penn Foster Career School - Scranton, PA
Currently taking on-line courses
California State University - Dominguez Hills - Carson, CA
Everest College - Alhambra - Alhambra, CA
John Muir High School - Pasadena, CA
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Resume Overview
School Attended
- Penn Foster Career School
- California State University - Dominguez Hills
- Everest College - Alhambra
- John Muir High School
Job Titles Held:
- PHARMACY COORDINATOR
- Pharmacy Technician
- Pharmacy Technician
Degrees
- Certificate Program: Medical Billing And Coding
- Pharmacy Technician Diploma
- HIGH SCHOOL DIPLOMA
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