Montgomery Street, San Francisco, CA94105(555) 432-1000, resumesample@example.com
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
03/2019 to CurrentPHARMACY COORDINATORBaptist Health South Florida | Boca Raton, FL,
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).
11/2014 to 04/2018Pharmacy TechnicianAssistrx | Philadelphia, PA,
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.
01/2008 to 06/2015Pharmacy TechnicianAssistrx | Albuquerque, NM,
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.
Strictly maintained customer and patient confidentiality with knowledge in compliance with Health Insurance Privacy and Portability Act (HIPPA) guidelines.
01/2014 to 05/2014Pharmacy TechnicianAssistrx | Boston, MA,
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
Expected in 2014Certificate Program: Certified Pharmacy Technician | California State Dominguez Hills, Carson, CAGPA:
Expected in 2008DIPLOMA | PHARMACY TECHNICIANEverest College, Alhambra, CAGPA:
Expected in 2005HIGH SCHOOL DIPLOMA | John Muir High School, Pasadena, CAGPA:
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