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Skills

  • Data entry
  • Payer-Specific Requirements Documentation
  • Escalation Handling for Urgent Requests
  • Receiving incoming supplies
  • Pharmacy and customer records management
  • Payer Communication Strategies
  • Documentation and record-keeping
  • FDA and ICH Guidelines
  • Laboratory Practices
  • Chronic Condition Drug Access Expertise

Work Experiences

  • Collaborated with the clinical pharmacist.
  • Achieved a 74% reduction in claim rejections.
  • Helped patients save money on their medical bills by suggesting generic alternatives to prescription medications.
  • Calculated dosages, filled prescriptions, and printed prescription labels with extreme precision.
  • Conducted detailed audits of prior authorization records, uncovering and resolving errors that saved the organization up to $13 in potential losses annually.
  • Non-routine issues such as third-party billing, computer system, and customer service issues were resolved by me.
  • Coordinated with prescribers to submit correct documentation.
  • Completed ongoing education in Lean, incorporating best practices for securing insurance approvals for new high-cost therapies, boosting department accuracy by 65%.
  • Double-checked patient data and billing information in order to identify and correct erroneous bills caused by system errors.
  • Cut down on response times.

Summaries

  • Provide excellent customer service and ensure that prescriptions are filled correctly.
  • Dedicated to learning, growing, and succeeding in Pharmacy.
  • Achieved a 15% increase in patient satisfaction.
  • Costs were consistently reduced while profits were increased.
  • Within Pharmacy, senior Prior Authorization Pharmacy Technician and outstanding performer in strategic planning and budget management.
  • Recognized on a regular basis for outstanding performance and contributions to the Pharmacy industry's success.
  • Achieved a 79% recovery in denied claims.
  • Achieved a 73% increase in authorization efficiency.
  • Achieved a 44% reduction in errors.
  • Achieved a decrease in denials by 16%.

Accomplishments

  • Led the creation of an appeals process template, achieving a 20% success rate in overturning initial rejections on process.
  • Assisted in navigating prior authorization challenges for high-priority cases, reducing medication waiting times for at-risk patients by 55%.
  • Proactively identified bottlenecks in the prior authorization process, resulting in a 64% reduction in processing times for high-cost medications.
  • Designed and conducted training webinars on prior authorization best practices, positively impacting the pharmacy department’s overall productivity by 77%.
  • Documented and resolved category which led to standard.
  • Implemented streamlined documentation protocols, ensuring compliance with payer guidelines and achieving a 16% increase in claim approvals.
  • Troubleshot and resolved prior authorization discrepancies in the EHR system, leading to a 19% reduction in errors within one year.
  • Used Microsoft Excel to develop inventory tracking spreadsheets.
  • Reduced claim rejection rates by 39% by implementing a new checklist system ensuring thorough cross-checking before submission.
  • Improved payer communication lines for specialty medications, ensuring a 55% faster resolution on time-sensitive authorizations.

Affiliations

  • Medication Access and Compliance Fellowship, Vantage
  • International Pharmaceutical Federation (FIP)
  • Accreditation Council for Pharmacy Education (ACPE)
  • American Society of Health-System Pharmacists (ASHP)
  • Health Plan Prior Authorization Policies Education, 2016
  • International Association of Administrative Professionals
  • National Pharmacy Technician Association (NPTA)
  • Freemason
  • National Association of Chain Drug Stores (NACDS)
  • American Medical Informatics Association

Certifications

  • Certified in Managed Care Pharmacy (CMCP) - Academy of Managed Care Pharmacy (AMCP)
  • Certified Compounded Sterile Preparation Technician (CSPT) - Brightline
  • Understanding Medicare Part D - Meridian - 2021
  • Certified Prior Authorization Pharmacist (CPAP) - Cedar Works
  • Pharmacy Technician Certificate Program - Cedar Works - 2021
  • Certified Specialty Pharmacy Technician (CSPT) - 2019 - Pharmacy Technician Certification Board (PTCB)
  • Certified Clinical Pharmacy Technician (CCPT) - Harbor & Co.
  • Pharmacology for Pharmacy Technicians Certificate - Brightline - 2015
  • HIPAA Professional Training & Certification - HubSpot - 2015
  • CompTIA Network+

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