prior authorization technician 1 resume example with 7+ years of experience
Hardworking Pharmacy Technician with successful background working closely with insurance company representatives to gain preapproval for procedures and testing. Detail-oriented performer with over 6 years of managing documentation. Considered team player with exemplary multitasking skills. Organized professional knowledgeable in regulatory standards and compliance requirements. Confident Prior Authorization Specialist with a background spent working in medical offices, communicating effectively orally and through writing and developing prior authorization workflows. Bilingual professional with skill in prior authorization for patients, finding solutions to issues and tackling work tasks in busy office.
· Knowledge in pharmacy practices, procedures and precedents; ability to read and understand pharmaceutical information · Working knowledge of drug dosage forms, drug strength, generic & trade name equivalent · Demonstrates knowledge of Federal & State laws/regulations regarding provisions of pharmaceutical services · Ability to multi-task and prioritize work · Ability to comprehend and follow established office routines, policies and procedures | · Customer service and interpersonal skills · Ability to adjust based on business/department needs · Demonstrated courteous and professional behavior · Proficient PC skills in a windows based environment · Excellent oral and written communication skills |
- Responsible for understanding and applying clinical criteria for processing Prior Authorization requests in a timely manner for pharmacy and medical billing.
- Responsible for making outbound calls/receiving inbound calls, speaking with physicians’ offices for additional information or clarifications needed to process prior authorization request.
- Strong knowledge in Specialty pharmaceuticals
- Ability to identify problems including complex issues and determine solutions, both independently or in a team/group setting
- Must be organized, detail-oriented and have excellent communication skills (oral, written, grammar, listening)
- Supports Fraud and Abuse program system oversight by reviewing medication utilization records. Communicates any suspected fraud discovered. Recommends course of action for providers where patterns appears outside of guidelines and generally accepted pharmacy standards.
- Keeps abreast of industry trends and regulatory changes in the pharmacy industry and incorporates knowledge in the performance of job duties. Identifies problems in process/procedures or services and makes recommendations for improvements. Maintains a balance of productivity, quality and timeliness of job accountabilities. Participates in department self-audit procedures for on-going evaluation of service.
- Maintains and updates internal databases. Enters application information, prior authorizations and other relevant data. Ensures database information and appended files are current and accessible to staff. Generates reports and other information requested on a scheduled/as needed basis.
- Creates and supports an environment which fosters teamwork, cooperation, respect and diversity. Establishes and maintains positive communication and professional demeanor with internal and external business partners at all times.
- Performs other related duties as assigned.
- Attends required training on an annual basis.
- Adheres to AMFC policies and procedures.
- Must be available to work weekends and holidays.
- Communicated with patients to collect information about prescriptions and medical conditions or arrange consultations with pharmacists.
- Consulted with insurance company representatives to complete claims processing, resolve concerns and reconcile payments.
- Communicated with prescribers to verify medication dosages, refill authorizations and patient information.
- Calculated dosage, filled prescriptions and prepared prescription labels with absolute accuracy.
- Assisted patients in minimizing medical expenses by recommending generic alternative prescription medications.
- Answered incoming phone calls and addressed questions from customers and healthcare providers.
- Counted and labeled prescriptions with correct item and quantity.
- Restocked automated medication dispensing equipment.
- Ordered medicines daily to replenish stock and increase inventory in anticipation of need.
- Restocked pharmacy shelves with current merchandise to drive consistent peripheral sales.
- Counted, measured and compounded medications following standard procedures.
- Entered and processed patients' prescriptions into internal system.
- Counted, measured, and compounded medications following standard procedures.
- Prepped all examination rooms, sterilized equipment and instruments and maintained appropriate tray setup.
- Educated patients on postoperative care and best practices for protecting dental work and boosting healing process.
- Taught patients strategies for boosting oral hygiene, controlling plaque and protecting tooth enamel from long-term damage.
- Poured and shaped molds from impressions and trimmed molds in grinder.
- Prepared patient for orthodontist and performed simple tasks such as tightening braces and conducting preliminary examinations.
- Helped Orthodontist complete routine and advanced procedures by preparing patients and instruments for expected needs.
- Assisted dentists by passing instruments, suctioning intraoral fluids, adding water and mixing materials for fillings, and impressions.
- Cleaned and sanitized dental tools and equipment, straightened treatment rooms and restocked supplies to prep for next patient and maintain health and safety practices.
- Assisted dentists, hygienists and other personnel by handing appropriate tools and supplies needed for procedures.
- Confirmed appointments, communicated with clients and updated client records.
- Restocked supplies and placed purchase orders to maintain adequate stock levels.
- Oversaw inventory activities, including materials monitoring, ordering or requisition and supply stocking or re-stocking.
- Kept reception area clean and neat to give visitors positive first impression.
- Escorted clients to correct spa areas including treatment rooms and offices.
- Learned details of types of treatments and procedures in order to answer questions from spa guests.
- Communicated with spa team members if clients canceled or changed appointment times.
- Trained new hires on new appointment scheduling, opening, closing duties and generating and balancing daily revenue reports.
- Kept calendar with scheduled appointments and scheduled massage therapists for appropriate treatments and time slots.
- Certified Pharmacy Technician
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Resume Overview
School Attended
- El Camino College
- Knightdale High School
Job Titles Held:
- Prior Authorization Technician 1
- Pharmacy Technician
- Orthodontic Assistant
- Receptionist
Degrees
- Certificate
- High School Diploma
By clicking Customize This Resume, you agree to our Terms of Use and Privacy Policy