Prior Authorization Coordinator resume example with 13+ years of experience

Jessica Claire
  • , , 609 Johnson Ave., 49204, Tulsa, OK 100 Montgomery St. 10th Floor
  • H: (555) 432-1000
  • C:
  • 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.

  • 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
Administrative Assistant, 2013 - 2017
William Backus Hospital Storrs, CT,
  • 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.
: Architecture, Expected in
Middlesex Community College - Bedford - Bedford, MA
High School Diploma: , Expected in 06/2007
Shawsheen Valley Regional Technical High School - Billerica, MA,
  • PhT - Commonwealth of Massachusetts Pharmacy Technician License

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Resume Overview

School Attended

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

Job Titles Held:

  • Prescription and Prior Authorization Team Lead
  • Prior Authorization Coordinator
  • Administrative Assistant
  • Pharmacy Technician


  • High School Diploma

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