prior authorization representative resume example with 6+ years of experience

Jessica Claire
  • Montgomery Street, San Francisco, CA 94105 609 Johnson Ave., 49204, Tulsa, OK
  • H: (555) 432-1000
  • C:
  • Date of Birth:
  • India:
  • :
  • single:
Skill Highlights
  • Client relations specialist
  • Conflict resolution techniques
  • Team management
  • Focused on customer satisfaction
  • Meticulous attention to detail
  • Skilled multi-tasker
    Training and development
  • Deadline-oriented
  • Exceptional interpersonal skills
  • Analytical problem solver
  • Trained in business development
  • Accomplished in relationship selling

Professional Experience
Prior Authorization Representative, 07/2014 - 07/2016
Aetna Inc. Stratford, NJ,
  • Analyze training needs to develop new training programs or modify and improve existing programs.
  • Conduct or arrange for ongoing technical training and personal development classes for staff members.
  • Plan, develop, and provide training and staff development programs, using knowledge of the effectiveness of methods such as classroom training, demonstrations, on-the-job training, meetings, conferences, and workshops.
  • Conduct orientation sessions and arrange on-the-job training for new hires.
  • Confer with management and conduct surveys to identify training needs based on projected production processes, changes, and other factors.
  • Train instructors and supervisors in techniques and skills for training and dealing with employees.
  • Develop testing and evaluation procedures.
  • Analyze training needs to develop new training programs or modify and improve existing programs.
  • Train and Manage 25-30 new hires through orientation and 4 weeks of on-the-job training.
  • Subject Matter Expert in regards to corporate policies and procedures.
  • Utilize knowledge to direct teams successfully while training and mentoring.
  • Review medication history, claims, and daily dosing for Pharmacists review.
  • Calculate dosing and FDA regulations for dosing information and maximum daily availability per patient's plan.
  • Work closely with Pharmacists to ensure efficiency and quality delivery of medications to patients.
  • Contact physician's offices regarding medication dosing, diagnosis, and continuity of care.
Subject Matter Expert/Prior Authorization , 01/2014 - 07/2014
Unitypoint Health Sergeant Bluff, IA,
  • Review insurance policy to determine coverage.
  • Prepare insurance claim forms or related documents and review them for completeness.
  • Post or attach information to claim file.
  • Transmit claims for payment or further investigation.
  • Contact insured or other involved persons to obtain missing information.
  • Answer applicants' questions about benefits and claim procedures.
  • Interpret and explain information such as eligibility requirements, application details, payment methods, and applicants' legal rights.
  • Initiate procedures to grant, modify, deny, or terminate assistance, or refer applicants to other agencies for assistance.
  • Interview clients and take their calls to provide customer service and obtain information on claims.
  • Process and record new insurance policies and claims.
  • Correspond with insured or agent to obtain information or inform them account status or changes.
  • Modify, update, and process existing policies and claims to reflect any change in beneficiary, amount of coverage, or type of insurance.
  • Transcribe data to worksheets and enter data into computer for use in preparing documents and adjusting accounts.
  • Compose business correspondence for supervisors, managers and professionals.
Oil Sales Executive, 04/2013 - 06/2013
  • Resolve customer complaints regarding sales and service.
  • Oversee regional and local sales managers and their staffs.
  • Plan and direct staffing, training, and performance evaluations to develop and control sales and service programs.
  • Review operational records and reports to project sales and determine profitability.
  • Monitor customer preferences to determine focus of sales efforts.
  • Prepare budgets and approve budget expenditures.
  • Direct and coordinate activities involving sales of manufactured products, services, commodities, real estate or other subjects of sale.
Pharmacy Technician, 10/2008 - 2013
  • Receive written prescription or refill requests and verify that information is complete and accurate.
  • Establish or maintain patient profiles, including lists of medications taken by individual patients.
  • Establish or maintain patient profiles, including lists of medications taken by individual patients.
  • Answer telephones, responding to questions or requests.
  • Prepack bulk medicines, fill bottles with prescribed medications, and type and affix labels.
  • Mix pharmaceutical preparations, according to written prescriptions.
  • Clean and help maintain equipment or work areas and sterilize glassware, according to prescribed methods.
  • Price and file prescriptions that have been filled.
  • Assist customers by answering simple questions, locating items, or referring them to the pharmacist for medication information.
  • Receive and store incoming supplies, verify quantities against invoices, check for outdated medications in current inventory, and inform supervisors of stock needs and shortages.
  • Order, label, and count stock of medications, chemicals, or supplies and enter inventory data into computer.
  • Transfer medication from vials to the appropriate number of sterile, disposable syringes, using aseptic techniques.
  • Supply and monitor robotic machines that dispense medicine into containers and label the containers.
  • Prepare and process medical insurance claim forms and records.
  • Deliver medications or pharmaceutical supplies to patients, nursing stations, or surgery.
  • Restock intravenous (IV) supplies and add measured drugs or nutrients to IV solutions under sterile conditions to prepare IV packs for various uses, such as chemotherapy medication.
  • Receive written prescription or refill requests and verify that information is complete and accurate.
  • Establish or maintain patient profiles, including lists of medications taken by individual patients.
Education and Training
High School Diploma: ALL, Expected in Jun 2003
Watterson High School - COLUMBUS, OH
Status -
Bachelor of Science: Health and Wellness Candidate, Expected in 2017
Status -

The National Society of Collegiate Scholars member

3.3 GPA

Bachelor of Science: Neuroscience, Expected in 2017
Ohio State University - Columbus, Ohio
GPA: Kaplan University Dean's List Fall quarter 2014
Status - Member of National Collegiate Scholars The Ohio State University
Professional Summary
To pursue a highly rewarding career, seeking for a job in challenging and healthy work environment where I can utilize my skills and knowledge efficiently for organizational growth. Advanced Training and Leaderships skills 5 years of Pharmacy technician management in the Inpatient and Outpatient sectors Airman of the Quarter (Pharmacy Technician) Jan-March 2011 Train and Manage 25-30 new Pharmacy representatives(4 classes so far in 2015). Nominated for the Emerging Leader program at Express Scripts for training and leadership excellence Qualifications I have over 5 years of management in the Pharmacy sector. I have my National Pharmacy Technician certification with 2 years in Inpatient and 3 years in Outpatient. The reasons why I am highly qualified for the position as the Operations Manager begins with my experience in different aspects of the Pharmacy sector. As a Technician in the Inpatient pharmacy, I managed other technicians, complied with regulations and standards in the Military Training Facility. Furthermore, I was in charge of delegating responsibilities to each airman to comply with checklist, operation standards, and Joint Commission regulations. As a Subject Matter Expert/Trainer, I help improve and processes, train new hires on code of conduct, facilitate any coordination with their specific supervision, and revise training procedures and skill sets pertaining to the new employee's job specification. I know I am more than capable to positively contribute to the operations and management by my previous experience and qualifications.
Additional Information
  • Credentials and License Certification #: 10037761 Certification Status: Active Expiration Date: 03/31/2016 Awards and Honors Pharmacy Technician Airman of the Quarter 2011-(January-March) Inpatient Pharmacy Technician-Airman of the Quarter April 2010 Emerging Leader Nomination-April 2015

aseptic techniques, benefits, budgets, budget, business correspondence, chemotherapy, commodities, conferences, Resolve customer complaints, clients, customer service, delivery, diagnosis, focus, forms, insurance, inventory, legal, meetings, mentoring, nursing, policies, processes, quality, real estate, robotic, sales, staff development, staffing, surgery, surveys, technical training, telephones, training programs, type, workshops, written

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Resume Overview

School Attended

  • Watterson High School
  • Ohio State University

Job Titles Held:

  • Prior Authorization Representative
  • Subject Matter Expert/Prior Authorization
  • Oil Sales Executive
  • Pharmacy Technician


  • High School Diploma
  • Bachelor of Science
  • Bachelor of Science

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