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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
  • Outpatient surgery coding specialist
  • Patient referrals expert
  • Familiar with commercial and private insurance carriers
  • Insurance and collections procedures
  • Understands insurance benefits 
  • Medical terminology expert
  • Billing and collection procedures expert
  • Records management professional
  • Records maintenance professional
  • Outpatient surgery coding specialist
Work History
Pharmacy Prior Authorization Specialist, 09/2005 to Current
 First Urology – 101 Hospital blvd Jeffersonville, IN
  • 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 – Louisville, KY
  • 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 – Louisville, KY

     

  • 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 – Louisville, KY
  • 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 – Louisville, KY
  • 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 - Mt. Washington, KY
    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

Companies Worked For:

  • First Urology
  • Norton Healthcare
  • National Health Services
  • Frost Arnett Co
  • Prudential Service Bureau

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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