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Prior Authorization Representative Resume Example

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PRIOR AUTHORIZATION REPRESENTATIVE
Summary
Dedicated and focused, A person who excels at prioritizing, completing multiple tasks simultaneously and following through to achieve project goals. Organized and Professional.
Highlights
  • Windows Internet
  • Knowledgeable Typing
  • CNA
  • Calculator
  • Microsoft
  • PowerPoint
  • Document Scanning
  • Label Maker
  • Photoshop
  • Public Administration Work
  • Cash Handling
  • Elderly Care Work
  • Microsoft EXCEL Customer
  • Service Copy Machine
  • Microsoft Publisher
  • Administrative Assisting
  • Multi-line Phone
  • Fax General Office Cashier
  • Scanner Reception Work         
  • Food Preparation
  • Child Care
  • Microsoft Outlook
  • Food Service
  • Human Resources
  • Microsoft Word
  • Administrative Work
  • Time management
  • Professional and mature
  • Strong problem solver
  • Resourceful
  • Dedicated team player
  • Strong interpersonal skills
  • Understands grammar
  • Proofreading
  • Medical terminology
  • Self-starter
  • Billing and coding
  • Insurance eligibility verifications
Accomplishments
Increased office organization by developing more efficient filing system and customer database protocols. Promoted to Manager after 6 months of employment.
Experience
12/2014 to 08/2015
Prior Authorization RepresentativeCompany Name － City, State
  • Handle inbound telephone and written inquiries from pharmacists and doctors regarding prior authorization by screening and reviewing requests based on benefit plan design, client specifics and clinical criteria.
  • Provide information to clients, participants, pharmacists and doctors regarding participants pharmacy benefit, drug coverage and provide accurate procedures for medication exceptions.
  • Facilitate resolution of drug coverage issues and pro-actively address, research and resolve issues while maintaining accurate and complete documentation of all inquires for continuous improvement.
  • Work collaboratively with other associates and supervisor to ensure that best practices are shared.
02/2013 to 10/2013
ReceptionistCompany Name － City, State
  • Managed the receptionist area, including greeting visitors and responding to telephone and in-person requests for information.
  • Designed electronic file systems and maintained electronic and paper files.
  • Served as central point of contact for all outside vendors needing to gain access to the building.
  • Made copies, sent faxes and handled all incoming and outgoing correspondence.
  • Properly routed agreements, contracts and invoices through the signature process.
  • Received and screened a high volume of internal and external communications, including email and mail.
  • Managed daily office operations and maintenance of equipment.


06/2011 to 12/2011
ServerCompany Name － City, State
  • Accepted payment from customers and made change as necessary.
  • Apportioned and served food to facility residents, employees, or patrons.
  • Checked patrons' identification to ensure that they met minimum age requirements for consumption of alcoholic beverages
  • Checked the quantity and quality of received products
  • Cleaned and maintained the beverage area, display cases, equipment, and order transaction area
  • Cleaned bars, work areas, and tables
  • Managed kitchen operations for high grossing, fast-paced fair concession kitchen.
  • Managed preparation and presentation of the desserts for all catered events.
  • Examined trays to ensure that they contained required items
  • Greeted guests and sat them at tables or in waiting areas
  • Instructed cooks and other workers in the preparation, cooking, garnishing, and presentation of food
  • Loaded dishwashers and hand-washed items such as pots, pans, knives
  • Performed dishwasher duties
  • Facilitated prompt and accurate seating and service of all guests.
01/2011 to 05/2011
CNACompany Name － City, State
  • Observing residents.
  • Reporting any health issues to the supervising nurse.
  • Taking care of a resident's personal hygiene, including bed bath, shaving, nail care etc.
  • Toileting residents.
  • Emptying catheter bags.
  • Monitoring vital signs including temperature, pulse, respiration and blood pressure.
  • Setting up of meal trays, and documenting food / fluid intake.
  • Feeding residents.
  • Serving nutritional supplements.
  • Making beds.
  • Keeping the residents space clean and tidy.
  • Bringing the resident to the therapy area.
  • Turning bedridden residents to prevent bedsores.
  • Note: Patients of long-term care facilities are known as Residents.
06/2008 to 12/2010
BusserCompany Name － City, State
  • Organized tables efficiently Served water and refilled glasses as and when needed Cleaned the dining area and serving stations Assisted in cleaning up spills Greeted guests with / in the absence of the hostess Made suggestions about menu selections when asked Handed customers' queries and concerns efficiently.
  • Assisted guests with making menu choices in an informative and helpful fashion.
  • Routinely cleaned table linens, table settings, glassware, windowsills, carpets, counters, floors, storage areas and service refrigerators.
  • Continually kept carpets and floor clear of debris.
  • Maintained a professional tone of voice and words at all times, including during peak rush hours.
  • Guided guests through the dining rooms and provided needed assistance.
  • Routinely checked menus to verify they were current, clean and wrinkle-free.
  • Completed opening and closing checklists according to set standards.
  • Actively complied with all health department regulations and rectified issues immediately.
  • Regularly cleaned host stand and buffet area.
  • Washed buffet, restaurant and banquet items, including silverware, dishes, cooking utensils, equipment and displays.
  • Cleaned dishes with detergent and rinsing and sanitizing chemicals in the 3-compartment sink.
10/2015 to Current
CCR-Protection Plan Prem TechCompany Name － City, State
  • Resolved customer complaints and concerns with strong verbal and negotiation skills.
  • Displayed courtesy and strong interpersonal skills with all customer interactions.
  • Processed an average of 80 inbound and outbound technical support calls.
  • Helped customers track and ship packages, responding to an average of [number] calls per day.
  • Support customers with online billing and account issues.
  • Researched issues on various computer systems and databases to resolve complaints and answer inquiries.
  • Referred difficult issues to upper management while maintaining positive rapport with customer.
  • Informed customers about issue resolution progress.
  • Supported customers having data connectivity issues.
  • Provided thorough support and problem resolution for customers.
  • 13 years of experience in Internet services.
  • Assisted customers with technical issues via email, live chat and telephone.
  • Provided real-time support to everyday users of DirecTv.
  • Developed and maintained positive customer relationships.
  • Worked with customer service supervisor to resolve customer concerns.
  • Handled a large volume of phone calls, chat and emails.
  • Identified opportunities to upsell product and services.
  • Maintained records, logs and the lifecycle of work requests.
  • ​
10/2015 to Current
Technical Support Company Name － City, State
Education
05/2010
High School DiplomaLafayette High School － City, State, United States
3.6 GPA
​
Skills
Administrative, Photoshop, blood pressure, Calculator, Cash Handling, Cashier, Child Care, continuous improvement, client, clients, Customer Service, documentation, Fax, General Office, Human Resources, long-term care, Microsoft EXCEL, Microsoft Outlook, Microsoft PowerPoint, Microsoft Publisher, Windows, Microsoft Word, Nursing, Copy Machine, Reception, Reporting, research, Scanner, Scanning, supervisor, supervising, tables, telephone, phones, Phone, therapy, Toileting, Typing, vital signs, written
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Resume Overview

School Attended

  • Lafayette High School

Job Titles Held:

  • Prior Authorization Representative
  • Receptionist
  • Server
  • CNA
  • Busser
  • CCR-Protection Plan Prem Tech
  • Technical Support

Degrees

  • High School Diploma

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