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Pharmacy Technician/ Appeal Coordinator Resume Example

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PHARMACY TECHNICIAN/ APPEAL COORDINATOR
Summary

Board-certified Pharmacy Technician excited to bring 20+ years of medical background to create a quality appeals and grievance team with in The Health Plan. Well versed in all elements of appeals and grievance. Highly proficient in building lasting relationships with patients and customers, and also coworkers, .

Skills
  • Time management
  • Quality assurance and control
  • Insurance billing
  • Communications
  • Organization
  • Planning and coordination
  • Process improvement
  • Customer service
  • CphT certification
  • Computer Skills with some experience with Word and Excel
Experience
06/2014 - CurrentPharmacy Technician/ Appeal CoordinatorThe Health Plan | Wheeling , WV
  • Collaborated closely with pharmacist and Medical directors to deliver high level of quality care to patients and patrons.
  • Retained strong medical terminology, familiar with ICD 10 and CPT codes to help better comprehend the policy and procedures within the pharmacy department
  • Worked in an Excel master spreadsheet to record appeals, denials and approvals.
  • Instructed clients on amounts covered under benefits plans in easy-to-understand terminology.
  • Improved operations by working with team members and customers to find workable solutions.
  • Provided excellent service and attention to customers through phone conversations.
  • Upheld privacy and security requirements established by HIPPA
  • Documented conversations with customers to track requests, problems and solutions.
  • De-escalated problematic customer concerns, maintaining calm, friendly demeanor.
  • Worked with Pharmacy supervisors and other appeal coordinators to develop pharmacy appeals processes and to maintain compliance with CMS, NCQA and BMS.
  • Participated in the creation of the OICS platform for appeals and grievances.
  • Handled all delegated tasks assigned in a timely manner.
  • Demonstrated self-reliance by meeting and exceeding workflow needs.
  • Attended training and operating standards, such as CQI to help understand quality improvement plans with in the company.
  • Kept records of quality records of Medicare appeals and grievances for the medicare plan manager call with compliance.
10/2005 - 06/2014Critical Care TechnicianBarnesville Hospital | Barnesville, OH
  • Maintained thorough, accurate and confidential documentation in electronic medical records.
  • Educated patients on treatment plans, medications and aftercare procedures.
  • Directed care for patients in ICU, including implementation of treatment plan, monitoring vitals.
  • Liaised between patients, families and care staff in all aspects of care delivery.
  • Advocated for patients by supporting and respecting basic rights, values and beliefs.
  • Utilized computerized Resource and Patient Management System (RPMS) and Electronic Health Record (EHR) system.
  • Stocked clinical workstations and procedure rooms with necessary supplies.
  • Prioritized patient care assignments based on patient conditions to achieve optimal outcomes.
  • Collaborated with interdisciplinary healthcare professionals to create, implement and adapt individualized care plans.
  • Managed all facets of telemetry, including dysrhythmia interpretation and chest tube management.
  • Improved operations by working with team members and customers to find workable solutions.
  • Demonstrated self-reliance by meeting and exceeding workflow needs.
10/2003 - 02/2006Pharmacy Technician Shift SupervisorRite Aid Pharmacy | Barnesville, OH
  • Ordered medicines daily to comply with demands and needs.
  • Compiled customer demographic, allergy and medical history background.
  • Prepared prescription transfer requests from competitor companies.
  • Restocked shelves and prepared expired drugs for return.
  • Verified labeled prescriptions using 8-point check system to maintain accuracy and efficiency.
  • Verified insurance benefits to refill medications and upheld fantastic customer service standards.
  • Participated in prescription pharmaceutical and over-the-counter product inventory audits.
  • Maintained clean and organized pharmacy shelving and work areas.
  • Adhered to regulatory guidelines for workplace safety and customer confidentiality.
  • Checked medications for content, accuracy and completeness of all drug packaging and labeling.
  • Verified prescriptions by contacting physicians' offices and receiving approval.
  • Delivered quality care to customers through close collaboration with pharmacist.
  • Worked with insurance companies to process claims, resolve problems and obtain payments.
  • Resolved third-party rejection claims.
  • Entered orders into system and filled medication orders.
  • Performed wide range of pharmacy operations with strong commitment to accuracy, efficiency and service quality.
  • Assisted upper management with daily operations to meet standards of service and quality.
  • Kept areas clean, neat and inspection-ready at all times to comply with product guidelines.
  • Trained employees in effective work procedures and performance strategies to optimize operations.
  • Patrolled work areas to inspect operations, identify concerns and implement corrective actions.
  • Created schedules and assigned jobs based on employee strengths and anticipated customer demand.
  • Collaborated with team members to improve performance and implement training updates.
  • Resolved customer complaints and reported issues to senior management.
  • Performed opening and closing procedures including setting up registers and arranging products to keep facility operations-ready.
Education and Training
05/1996High School Diploma
Barnesville High School | Barnesville, OH
05/2002Associate of Applied Science: Registered Nursing
Belmont College | Saint Clairsville, OH
Certifications
  • Certified Pharmacy Technician (CPhT)
  • First Aid/CPR
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Resume Overview

Companies Worked For:

  • The Health Plan
  • Barnesville Hospital
  • Rite Aid Pharmacy

School Attended

  • Barnesville High School
  • Belmont College

Job Titles Held:

  • Pharmacy Technician/ Appeal Coordinator
  • Critical Care Technician
  • Pharmacy Technician Shift Supervisor

Degrees

  • 05/1996 High School Diploma
    05/2002 Associate of Applied Science : Registered Nursing

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