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prior authorization specialist resume example with 18+ years of experience

Jessica Claire
  • , , 609 Johnson Ave., 49204, Tulsa, OK 100 Montgomery St. 10th Floor
  • Home: (555) 432-1000
  • Cell:
  • resumesample@example.com
  • :
Summary

Client-centered and motivated customer service professional committed to engaging others and delivJessicag exceptional service. Proven history of accurately overseeing a variety of administrative tasks in fast-paced settings. FostJessicag communication and team work to meet team, individual and management objectives. Adds value to any organization in need of great collaboration, interpersonal, and multitasking abilities. Meets tight deadlines every time.

Skills
  • Problem resolution
  • Analytical
  • Issue research
  • Maintaining strict confidentiality protocols
  • Working collaboratively
  • Organizational skills
  • Customer service
  • Telephone etiquette
  • Practitioner order verification
  • Understanding of medical terms
  • Precertification requirements
  • Insurance information oversight
Experience
Prior Authorization Specialist, 10/2017 to 11/2021
Dana-Farber Cancer InstituteBoston, MA,
  • Contacted insurance companies to obtain necessary pre-preauthorizations needed for upcoming tests and procedures.
  • Provided accurate information to all parties, including patients, insurance providers, healthcare staff and office personnel by using effective written and verbal communication skills.
  • Performed detailed medical reviews of prior authorization request, following established criteria and protocols.
  • Notified ordJessicag providers of denied authorizations.
  • Identified reasons behind denied claims and worked closely with insurance carriers to promote resolutions.
  • Scheduled peer to peer reviews for physicians to discuss medical necessity with insurance providers.
  • Clarified patient inquiries and questions to update patient account information in computer system.
  • Collaborated with internal departments to provide account status updates.
Pharmacy Technician / Front Store Clerk, 02/2016 to 10/2017
Eaton CorporationSeattle, WA,
  • Receive and enter written and electronic prescriptions and refill requests
  • Gather and record patient information before prescriptions can be dispensed
  • Contact insurance companies to resolve claim issues Effectively listen and address patient concerns regarding insurance cop-payments, prescription refills and basic medication dispensing.
  • Maintain, order and log pharmacy inventory of supplies and non CII medications
  • Maintain files of filled prescriptions
  • Open the store for business and secure the store at the end of the day
  • Accurately maintain a cash drawer
  • Count down registers and complete paperwork necessary for daily bank deposit
Product Specialist, 09/2011 to 02/2016
Perrigo PharmaceuticalsCity, STATE,
  • Answers inbound consumer telephone calls regarding OTC and Rx product questions and complaints.
  • Processes time sensitive product inquiries and complaints from outside business partners’ emails and reports.
  • Personally contacts complainants to research and resolve their concerns.
  • Performs detailed and specific data entry of product inquiries and complaints per FDA regulations.
  • Retrieves complaint product for quality evaluations and investigation according to FDA regulations.
  • Adheres to company policies for submitting refunds or replacement products for complainants.
  • Contacts outside business partners to advise of case resolution.
Shift Supervisor Level, 08/2003 to 09/2011
CVS PharmacyCity, STATE,
  • Assisted upper management with daily operations to meet standards of service and quality.
  • Resolved customer complaints and reported issues to senior management.
  • Completed opening and closing duties to facilitate business operations.
  • Coordinated shift-based inventory receiving, auditing and restocking.
  • Counted cash on hand at shift change and closing to determine shortages or overages and prepare bank deposit statements.
  • Delegated tasks to employees and monitored activities and task completion.
  • Supervised, motivated and led employees to maintain productivity and customer service levels.
  • Upheld company standards and compliance requirements for operations and cleanliness.
Education and Training
General Education Certificate: , Expected in 01/1988 to Courtland High School - Spotsylvania, VA
GPA:
Activities and Honors

Virginia State Licensed Pharmacy Technician (2003-2018) Customer Service Certificate – Rockhurst University (13DEC2014) National Licensed Pharmacy Technician (2003-2015)

Accomplishments
  • Developing Your Emotional Intelligence Business Grammar and Proofreading How to Communicate with Tact, Professionalism and Diplomacy Strengthening Your People Skills in the Workplace Managing Multiple Priorities and Projects 7 Keys to Exceptional Personal productivity.

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Resume Overview

School Attended

  • Courtland High School

Job Titles Held:

  • Prior Authorization Specialist
  • Pharmacy Technician / Front Store Clerk
  • Product Specialist
  • Shift Supervisor Level

Degrees

  • General Education Certificate

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