LiveCareer
LiveCareer
  • Dashboard
  • Jobs
  • Resumes
  • Cover Letters
  • Resumes
    • Resumes
    • Resume Builder
    • Resume Examples
      • Resume Examples
      • Nursing
      • Education
      • Administrative
      • Medical
      • Human Resources
      • View All
    • Resume Search
    • Resume Templates
      • Resume Templates
      • Nursing
      • Education
      • Medical
      • Human Resources
      • Customer Service
      • View All
    • Resume Services
    • Resume Formats
    • Resume Review
    • How to Write a Resume
    • CV Examples
    • CV Formats
    • CV Templates
    • Resume Objectives
  • Cover Letters
    • Cover Letters
    • Cover Letter Builder
    • Cover Letter Examples
      • Cover Letter Examples
      • Education
      • Medical
      • Human Resources
      • Customer Service
      • Business Operations
      • View All
    • Cover Letter Services
    • Cover Letter Templates
    • Cover Letter Formats
    • How to Write a Cover Letter
  • Jobs
    • Mobile App
    • Job Search
    • Job Apply Tool
    • Business Letters
    • Job Descriptions
  • Questions
  • Resources
  • About
  • Contact
  • 0Notifications
    • Notifications

      0 New
  • jane
    • Settings
    • Help & Support
    • Sign Out
  • Sign In
Member Login
  • LiveCareer
  • Resume Search
  • Prior Authorization Coordinator
Please provide a type of job or location to search!
SEARCH

Prior Authorization Coordinator Resume Example

Resume Score: 80%

Love this resume?Build Your Own Now
PRIOR AUTHORIZATION COORDINATOR
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.
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.

Work History
Prior Authorization Coordinator, 12/2017 to Current
Company Name - City, State
  • 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
Administrative Assistant, 2013 to 2017
Company Name - City, State
  • 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 to 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
ArchitectureMiddlesex Community College - Bedford - City, State
High School Diploma: : 06/2007Shawsheen Valley Regional Technical High School - City
Certifications
  • PhT - Commonwealth of Massachusetts Pharmacy Technician License
Build Your Own Now

DISCLAIMER

Resumes, and other information uploaded or provided by the user, are considered User Content governed by our Terms & Conditions. As such, it is not owned by us, and it is the user who retains ownership over such content.

Resume Overview

School Attended

  • Middlesex Community College - Bedford
  • Shawsheen Valley Regional Technical High School

Job Titles Held:

  • Prior Authorization Coordinator
  • Administrative Assistant
  • Pharmacy Technician

Degrees

  • Architecture
    High School Diploma : : 06/2007

Create a job alert for [job role title] at [location].

×

Advertisement

Similar Resumes

View All
Prior-Authorization-Coordinator-resume-sample

Prior Authorization Coordinator

Irving, Texas

TRICARE-Prior-Authorization-Coordinator-resume-sample

TRICARE Prior Authorization Coordinator

Gilbert, Arizona

Prior-Authorization-Intake-Coordinator-resume-sample

Prior Authorization Intake Coordinator

Houston, Texas

About
  • About Us
  • Privacy Policy
  • Terms of Use
  • Sitemap
Help & Support
  • Work Here
  • Contact Us
  • FAQs
Languages
  • EN
  • UK
  • ES
  • FR
  • IT
  • DE
  • NL
  • PT
  • PL
Customer Service
customerservice@livecareer.com
800-652-8430 Mon- Fri 8am - 8pm CST
Sat 8am - 5pm CST, Sun 10am - 6pm CST
  • Stay in touch with us
Site jabber winner award

© 2021, Bold Limited. All rights reserved.