prior authorization pharmacy technician resume example with 13+ years of experience
JessicaClaire
, , 100 Montgomery St. 10th Floor(555) 432-1000, resumesample@example.com
Professional Summary
Results-oriented certified pharmacy technician with over 10 years of experience in retail, clinical, and mail order pharmacy in a call center setting. Possess strong patient relations. Knowledgeable of regulatory guidelines and inventory management, prior authorizations, benefit investigations and financial assistance programs. Analytical thinker with the ability to perform well under pressure. Goal- and team-oriented with strong leadership skills and a commitment to team quotas. Dedicated, hard-working, reliable and accurate courteous service at all times.
Skills
EPIC
IC+
Communication
Problem-solving
Maintaining strict confidentiality
Motivated Self Starter
Eager to Learn
Time management
Project managemen
Prior Authorization Processing
Drug Formularies
Medicare and Medicaid Processes
Computer Billing Systems
HIPAA
Organizational skills
Committed to quality system
Microsoft Office/Outlook
Telephone etiquette
Being able to work under pressure.
Work History
08/2017 to 06/2023Prior Authorization Pharmacy TechnicianCvs Health | North Charleston, SC,
Provided accurate information to all parties, including patients, healthcare staff and office personnel by using effective written and verbal communication skills
Clarified patient inquiries and questions to update patient account information in computer system
Applied knowledge of Medicare, Medicaid and third-party payer requirements utilizing on-line eligibility systems to verify patients coverage and policy limitations
Notified order provides of denied authorizations
Identified reasons behind denied claims, and worked with insurance carriers to promote resolutions
Performed detailed medical reviews of prior authorization request, following established criteria and protocols
Followed all Medicare, Medicaid, HIPPA and private insurance regulations and requirements.
03/2021 to 09/2021CLINIC STAFF ASSISTANTUs Oncology, Inc. | Glendale, AZ,
Support medical front office business operations in an outpatient clinical setting
Maintain a patient centered attitude at all times, demonstrating compassion and empathy for patients and their families
Learn and maintain up-to-date knowledge of Epic electronic medical record EMR system user operations, front office clinical workflows and policies and procedures
Deliver superior customer service, representing UT Southwestern in a positive and professional manner to patients, colleagues and the community
Communicated with internal and external team members to ensure best outcomes for the patient in a comprehensive clinical care model
Maintained patient confidentiality in accordance with HIPPA and UT Southwestern policy
Maintained neatness of customer waiting area; keeps area stocked with pamphlets and other materials as appropriate
Ensured adequate inventory of items necessary for day-to-day functions of clinic, such as office supplies and patient forms
11/2016 to 08/2017PATIENT CARE COORDINATORKroger | Bluffton, IN,
Answered inbound patients calls, emails and questions
Made outbound calls for refilling their specialty medications
Performed clinical consults with the patients
Answered basic clinical and program inquires
Coordinated access to therapies, scheduled and conducted appropriate follow-up, and facilitated access to appropriate support services
Facilitated access to appropriate support services, including reimbursement counseling, nursing hotline and support.
Supported payer research, healthcare policy library and state management
Followed up with patients and providers via phone, mail and/or fax for missing enrollment information
04/2010 to 08/2017Senior Certified Pharmacy TechnicianWalgreens | City, STATE,
Directly supervised eight pharmacy technicians, interns and support staff while on duty
Maintained pharmacy inventory by checking pharmaceutical stock to determine inventory level, anticipating needed mediations, and supplies, placing and expediting orders, verifying receipt, removing outdated drugs
Maintained a safe and clean pharmacy by complying with procedures, rules, and regulations
Organized medications for pharmacist to dispense by reading medication orders and prescriptions, preparing labels, calculating quantities, assembling intravenous solutions and other pharmaceutical therapies
Maintained records by recording and filing physicians orders and prescriptions
Coordinated the pharmacy staff schedule and assisted with personnel monitoring and performance evaluations
Verified insurance benefits and resolved rejected claims
Perform various collection actions including contacting patients by phone, and correcting and resubmitting claims to third party payers
Education
Expected in 2021 to to B.S | HEALTHCARE MANAGEMENTUNIVERSITY OF TEXAS, TYLER, GPA:
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