Prior Authorization Specialist resume example with 5 years of experience

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

Organized and motivated employee eager to apply time management and organizational skills in various environments. Seeking entry-level opportunities to expand skills while facilitating company growth.

  • Understanding of medical terms
  • Practitioner order verification
  • Issue Research
  • Precertification requirements
  • Patient Health Information Access
  • HIPAA Compliance
  • Arranging Discharges
  • Medical Terminology
  • Medical Charting
  • Customer Service
  • Unit Administrative Support
  • Patient Billing
  • Cash Handling
  • Collaboration and Teamwork
  • Data Entry
  • Insurance Authorizations
  • Proper Labeling Procedures
  • Verifying Orders
  • Ordering and Stocking Medications
  • Answering and Routing Calls
  • Cash Register Operations
  • Payment Processing
  • Dispensing Medications
  • Patient Profile Setup
  • ERP Software
  • Detail-Oriented
  • Workflow Optimization
  • Supporting Pharmacy Operations
  • Insurance Billing
  • Resolving Customer Issues
03/2022 to Current
Prior Authorization Specialist Gila Regional Medical Center Silver City, NM,
  • Performed detailed medical reviews of prior authorization request, following established criteria and protocols.
  • Coordinated resolutions for issues and appealed denied authorizations.
  • Notified ordering 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.
07/2017 to 04/2022
Pharmacy Technician Molina Healthcare Inc. Syracuse, NY,
  • Assisted pharmacist with clearing high volume of prescriptions and responded to customer questions.
  • Interpreted and processed medication orders under supervision of pharmacist.
  • Received and verified daily incoming drug inventories, reported discrepancies and logged items into inventory system.
  • Refilled medications, offered insight into over-the-counter products and verified insurance benefits.
  • Flagged potential side effects and allergies to prescribed medications for patients.
  • Verified prescriptions and drug labels, documents and packages.
  • Maintained strict patient confidentiality to adhere to HIPAA regulations and avoid data compromises.
  • Maintained clean and organized pharmacy shelving and work areas.
  • Verified patients' identities at pickup to prevent sale of wrong medications.
  • Managed inventories, rotated stock, removed expired or damaged drug products and resolved discrepancies in drug counts.
  • Efficiently processed cash register transactions for new and refilled prescription orders.
  • Completed and filed patient paperwork, updating records in system with insurance carrier changes and allergy information.
  • Prepared prescription labels, promoting accuracy in medication administration and dosing.
  • Worked with insurance companies to process claims, resolve problems and obtain payments.
  • Established and updated patient profiles, medications and insurance details.
  • Consulted with customers via telephone or in-person to assist with navigating pharmacy systems and completing requests.
  • Educated patients on prescription instructions and answered questions regarding drug side effects.
  • Created new customer profiles and updated demographics, allergies and new medications in pharmacy computer systems.
  • Prepared prescription transfers to other pharmacies.
  • Teamed with peers, technicians and pharmacists to prioritize and complete orders.
  • Performed wide range of pharmacy operations with strong commitment to accuracy, efficiency and service quality.
07/2021 to 03/2022
Lab Processing Specialist EAST ALABAMA HEALTH City, STATE,
  • Receive lab orders from physicians office
  • Verify patient's demographics and enter data into database
  • Process physicians lab orders
  • Verified lab orders to ensure correct test are entered for lab processing
  • Label specimens correctly for accurate processing
  • Place blood specimens in centrifuge
  • Transfer specimens to correct departments
  • Verify and bill patients insurance correctly
03/2020 to 07/2021
Personal Care Medical Technician EAST ALABAMA HEALTH City, STATE,
  • Provided excellent patient support and care to patients and families.
  • Observed and recorded vital signs and reported changes to physicians or nurses.
  • Adhered to all safety and infection control precautions and regulations.
  • Supported healthcare teams in consistently delivering timely and quality care according to company standards.
  • Monitored patients for medical changes and reviewed and revised care plans accordingly.
  • Monitored medical supply inventory to ensure consistent availability of critical items.
  • Reported safety hazards to supervisors, removing risk and promoting workplace safety.
  • Protected patients and employees by adhering to infection-control and hazardous waste policies.
  • Collected specimens for lab testing, practicing aseptic technique to reduce risk of infection.
  • Communicated with patients to explain specimen collection procedures and answer questions.
  • Performed blood draws while offering compassionate care.
  • Documented and updated patient data on electronic medical charts, maintaining accuracy and confidentiality.
Education and Training
Expected in 05/2015
Certificate: Cosmetology
Southern Union State Community College - Opelika, AL,

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Resume Overview

School Attended

  • Southern Union State Community College

Job Titles Held:

  • Prior Authorization Specialist
  • Pharmacy Technician
  • Lab Processing Specialist
  • Personal Care Medical Technician


  • Certificate

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