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PHARMACY COORDINATOR Resume Example

Resume Score: 80%

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PHARMACY COORDINATOR
Professional Summary
  • Seeking a position in HEALTH CARE SERVICES as a PATIENT AUTHORIZATION REPRESENTATIVE where my continuing education, years of experience and professional training as a PHARMACY TECHNICIAN/PRIOR AUTHORIZATION COORDINATOR will be effectively utilized to provide comprehensive services and direct client care. Also seeking to advance within a company and take on more responsibilities as I gain necessary knowledge. Licenses In good standing with the California State Board of Pharmacy-Pharmacy Technician TCH 81163 In good standing with the National Pharmacy Technician Certification Board as a Certified Pharmacy Technician (CPhT) Certification Number 10064132 Skill Highlights
  • 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 experience in prior authorization review, maintain 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
  • Professional understanding of Medicare processing and HIPAA guidelines
Work History
PHARMACY COORDINATOR, 03/2019 to Current
Regal Medical Group – Arcadia, CA
  • 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).
Pharmacy Technician, 11/2014 to 04/2018
HEALTH NET – Woodland Hills, CA
  • 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.
Pharmacy Technician, 01/2008 to 06/2015
RITE AID PHARMACY – Altadena, CA
  • 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.
Pharmacy Technician, 01/2014 to 05/2014
Care 1st – Monterey Park, CA
  • Input and document PA request determination.
  • Notified physicians/providers and members (when necessary) of PA request determination.
  • Communicated routinely with client health plans to assist with PA entry.
  • Maintained Prior Authorization documents, databases and records.
  • Participating member of Pharmacy Services Team, ensuring that all documentation was completed accurately, on time and within HIPAA requirements.
  • Received incoming prior authorization (PA) requests via phone or facsimile from physicians/providers.
  • Established professional, continuous communications with physicians/providers via phone or facsimile when additional information was required.
  • Held requests for further review pending receipt of requested information from providers/physicians.
Education
Certificate Program: Certified Pharmacy Technician: 2014
California State Dominguez Hills - Carson, CA
DIPLOMA: PHARMACY TECHNICIAN, 2008
Everest College - Alhambra, CA
HIGH SCHOOL DIPLOMA: 2005
John Muir High School - Pasadena, CA
Highlights
  • Analytical skills
  • Good listening skills
  • Relationship-Building
  • Data management
  • Authorizations Understanding
  • Policy Application
  • Performance Monitoring
  • Insurance Authorization
  • Patient Data Privacy
  • Organization and Time management
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Resume Overview

Companies Worked For:

  • Regal Medical Group
  • HEALTH NET
  • RITE AID PHARMACY
  • Care 1st

School Attended

  • California State Dominguez Hills
  • Everest College
  • John Muir High School

Job Titles Held:

  • PHARMACY COORDINATOR
  • Pharmacy Technician

Degrees

  • Certificate Program: Certified Pharmacy Technician : 2014
    DIPLOMA : PHARMACY TECHNICIAN , 2008
    HIGH SCHOOL DIPLOMA : 2005

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