Prior Authorization Coordinator resume example with 13+ years of experience
JessicaClaire
, , 609 Johnson Ave., 49204, Tulsa, OK100 Montgomery St. 10th Floor
H: (555) 432-1000
C:
resumesample@example.com
Date of Birth:
India:
:
single:
Professional Summary
Goal-oriented and welcoming with proven history of modernizing traditional practices to maximize patient satisfaction. Dedicated to organization and collaboration with over 3 years in the Prior Authorization field, with several years of pharmacy and multiple types of insurance background. I am enthusiastic, and eager to contribute to team success through hard work, attention to detail and organizational skills. I am motivated to learn and grow with the company and team in order to make every patients experience an excellent one.
Skills
Prior Authorizations
Prescription Coordination
Critical thinking
Problem Solver
Excellent Reading comprehension
Adaptability to all current and continued medical practice and prescription law changes.
Relationship-Building with other team mates as well as upper management and outside affiliates.
Records and Tracking Management
Confidentiality and HIPAA
Answering Patient and Provider Questions
Medication dispensing
Multitasker
Reliable and Dependable
Goal Oriented
Dedicated to provided the best patient care possible.
Work History
Prescription and Prior Authorization Team Lead, 04/2021 - Current Lakeside Medical – Orange, CA,
Promoted into Team Lead of both Prescription Refills and Prior Authorization teams.
Currently hold MA State Pharmacy Technicians License.
EMA EMR Super User
Directed and supervised both teams engaged in multiple EMR systems on Refills and Prior Authorizations for Procedures, Injectables as well as topical and oral medications.
Coached team members in Insurance techniques necessary to complete job tasks.
Trained new team members by relaying information on company procedures and safety requirements.
Evaluated employee skills and knowledge regularly, training and mentoring individuals with lagging skills.
Organize Metrics and provide monthly and weekly numbers to upper management
Prepared detailed reports on updates to project specifications, progress, identified conflicts and team activities.
Knowledge of Athena, EMA, Centricity, Quanum, Efax systems, Online Insurance Portals.
Prior Authorization Coordinator, 12/2017 - Current Risk Strategies Company – Dallas, TX,
Verifies eligibility and compliance with authorization requirements for all patients medications, specialty medications, and procedures.
Submits as well as tracks previously submitted prior authorizations to most major insurance companies.
Created and maintains spreadsheets logging all medical procedures, and medication authorizations including applicable denials and approvals.
Fields telephone inquiries on authorization details from plan members and medical staff in order to provide the most accurate and up to date information on all claims and tasks.
Prepares and distributes denial letters, and provides accurate information detailing reasons for denial and possible appeal measures to all providers.
Creates Letters of Medical Necessity and Appeals Packets for cases that require further action after being denied in order for patients to receive coverage of the requested medication.
Collaborates with RX Coordinators to process patients lacking coverage for specialty medications with patient assistance programs.
Escalates requests for all types of medications and procedures when applicable.
Completes and files all statistic documentation for PA Tracking purposes.
Implemented new EMR systems, as well integrated new outside affiliates to take control of Biologic RXs for APDerm New Hampshire patients.
Coordinated and assigned daily tasks to each member of the PA team in order to streamline and create a more productive workflow.
Maintains and tracks all incoming faxes for a better understanding of increased practice volume.
Completes skilled administrative work to support all office staff and operational requirements.
Operates and assists with PA and RX phone calls on a multi system phone line
Maintains compliance with patient privacy and security regulations such as HIPAA
Executed record filing system to improve document organization and management.
Updated all accident cases from all Insurance Adjusters in company owned data entry system.
Provided updates and service to customers regarding the status of their accident claim, as well as provide case updates to most major insurance companies and claims adjusters.
Monitored claim adjusters work logs and assisted in scheduling appointments and meetings.
Faxed and delegated daily tasks and claims to insurance adjusters for coverage of all Massachusetts towns in our coverage district.
Worked to accommodate new and different insurance requests and explored new value opportunities to optimize insurance agency reputation.
Managed documents by organizing forms, making photocopies, filing records, preparing correspondence and creating reports.
Pharmacy Technician, 08/2006 - 2013 Company Name – City, State,
Consulted with insurance company representatives to complete claims processing, resolve concerns and reconcile payments.
Communicated with patients to collect information about prescriptions and medical conditions or arrange consultations with pharmacists.
Restocked pharmacy shelves with current merchandise to drive consistent peripheral sales.
Helped pharmacist clear problematic prescriptions and address customer questions to keep pharmacy efficient.
Assisted pharmacist by filling prescriptions for multiple customers daily and responding to patient questions regarding prescription and medication-specific issues.
Stocked, labeled and inventoried medication to keep accurate records.
Counted and labeled prescriptions with correct item and quantity.
Monitored ordering of pharmacy medication stock to maintain streamlined inventory and low overhead.
Ordered medicines daily to replenish stock and increase inventory in anticipation of need.
Reviewed and verified customer information and insurance provider information.
Collected co-payments or full payments from customers.
Maintained proper drug storage procedures, registries, and records for controlled drugs.
Communicated with prescribers to verify medication dosages, refill authorizations and patient information..
Answered incoming phone calls and addressed questions from customers and healthcare providers.
Solved customer problems in-person or over telephone by providing assistance with placing orders, navigating systems and locating items.
Set up and modified patient profiles in NEXGEN to include current information such as medications and insurance details.
Performed wide range of pharmacy operations with strong commitment to accuracy, efficiency and service quality.
Education
: Architecture, Expected in - Middlesex Community College - Bedford - Bedford, MA GPA:
High School Diploma: , Expected in 06/2007 - Shawsheen Valley Regional Technical High School - Billerica, MA, GPA:
Certifications
PhT - Commonwealth of Massachusetts Pharmacy Technician License
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