Pharmacy Prior Authorization Specialist Resume Example
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PHARMACY PRIOR AUTHORIZATION SPECIALIST
Professional Summary
23 years experience in customer service with 17 years in healthcare benefits. My goal is to work for a company where I can utilize my training and be part of a team environment.
Skills
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Work History
Pharmacy Prior Authorization Specialist, 09/2005 to Current
Veritext – Atlanta , GA
Veritext – Atlanta , GA
- Complete FMLA and Short term Disability forms for all patients of 32 doctors
- Obtain Prior Authorizations for denied medications for 19 doctors
- Check in patients, take co-pays and post them as well as balance the days money
- Check out patients and schedule future appointments and testing
- Professionally and courteously verify appointment times with patients.
- Assist in the maintenance of medical charts and/or electronic medical record (filing, Op Reports, test results, home care forms).
- Diligently file and follow up on third party claims.
- Assign appropriate medical codes with a number percent accuracy rate.
- Determine prior authorizations for medication and outpatient procedures.
- Pre-certify medical and radiology procedures, surgeries and echocardiograms.
- Maintain strict patient and physician confidentiality.
- Submit electronic/paper claims documentation for timely filing.
- Identify and resolve patient billing and payment issues.
- Treat all patients, their families, visitors, peers, staff and providers in a pleasant and courteous manner.
- Schedule appointments, register patients and distribute sample pharmaceuticals as prescribed.
Billing Associate, 12/2002 to 09/2005
Norton Healthcare – City , STATE
Norton Healthcare – City , STATE
- Schedule appointments, register patients and distribute sample pharmaceuticals as prescribed.
- Accurately complete appropriate claims paperwork, documentation and system entry.
- Professionally and courteously verify appointment times with patients.
- Verify patients' eligibility and claims status with insurance agencies.
- Assign appropriate medical codes with a number percent accuracy rate.
- Determine prior authorizations for medication and outpatient procedures.
Care Manger Assistant, 04/2000 to 11/2002
National Health Services – City , STATE
National Health Services – City , STATE
- Professionally and courteously answere incoming calls for procedure pre-certifications.
- Utilize excel spreadsheets daily
- ICD9 and CPT coding
Secretary/ Bookkeeper, 03/1998 to 04/2000
Frost Arnett Co – City , STATE
Frost Arnett Co – City , STATE
- Answer 15 line phone system, update data base, filing and computer input
- 10 person staff, online bookkeeping and operating various office equipment
- Contact for client questions
- Account receivable post and deposit
Acct Specialist, Claims Examiner, 04/1989 to 03/1992
Prudential Service Bureau – City , STATE
Prudential Service Bureau – City , STATE
- Handle and resolve customer complaints. Communicate directly with benefit representatives and healthcare carriers regarding customer service needs and grievances
- ICD9 and CPT coding
- Various computer reports to ensure accurate and timely reporting of participant payments and benefits status
- Process enrollment forms, claim forms, preliminary information sheets and correspondence
- Performe duties as medical claim examiner for 3 years
- Investigate rejected claims or payment
Education
High School Diploma: Business/ accounting, 1982
Bullitt East H.S - City, State
Bullitt East H.S - City, State
- Received on the job training in
- Continuing education in COBRA regulations
- ICD9 and CPT coding
- Medical claims payer course
- Training in customer service and diversity training
- Knowledge of industry related computer systems which involved creating industry forms for training data entry
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Resume Overview
School Attended
- Bullitt East H.S
Job Titles Held:
- Pharmacy Prior Authorization Specialist
- Billing Associate
- Care Manger Assistant
- Secretary/ Bookkeeper
- Acct Specialist, Claims Examiner
Degrees
- High School Diploma : Business/ accounting , 1982
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