Pharmacy/ Customer Service
Resume:
LaToya Tharrington
*****************@*****.***
(N. Chesterfield, VA)
SUMMARY
Well-rounded and result oriented Customer Service/Pharmacy Representative with experience providing providers with deliverables including invoice reports, dispute documentation, long term care authorizations, Medicare Part D, TennCare and Medicaid prior authorizations, pharmacy audits, rebates, copay and grant assistance.
Developed and produced accurate and timely reports to track pharmacy related expenses; made recommendations to streamline processes where appropriate
Proficient in all Windows environments and have excellent desktop and user support experience.
Strong interpersonal and communication skills through mentoring and coaching.
Inbound and Outbound call center experience, Customer Service (over the phone, in person)
Computer literacy, attention to detail, strong data entry and filling skills, multi-task between different computer systems, and phone etiquette
Retail, Specialty, and long-term care experience in pharmacy
Able to identify barriers, elevate issues, and provide excellent problem-solving skills
Able to work independently and/or in a team, able to establish strong relationships with customers and or clients (insurance company’s)
EDUCATION
Bachelor of Science in Accounting, Elizabeth City State University, Elizabeth City, NC May 2010
Honors:
Sigma Beta Delta Honor Society Spring 2009 – Spring 2010
B.E. Scholar-Secretary/Vice President Spring 2008 – Spring 2010
Activities:
Volunteer Work Brett Haven Rest Home Summer 2008
ROTC Fall 2006 – Spring 2007
National Association of Black Accountants Fall 2008 – Spring 2010
National Black MBA Association-Secretary Fall 2008 – Spring 2010
PROFESSIONAL EXPERIENCE
Clinical Technician, LTC Solutions, Mechanicsville, VA Feb 2016 – Jul 2017
Made outbound calls to insurance companies to obtain prior authorizations and or appeals for specialty and maintance medications
Evaluated and authorized approval of prior authorization pharmacy requests from prescribers received by
telephone and/or facsimile using client clinical criteria and CoverMyMeds database
Reached out to insurance plans (HMO, PPO, Medicaid, TennCare and Medicare Part D) to obtain approvals, and appeal in denials from insurance company
Researching patients PBM to obtain prior authorizations for patient’s medications
Obtained reimbursements/rebates for the facilities by getting prior authorization approved, appeals approved, one-time overrides, and or transition fill overrides through insurance companies
Determined appropriateness for medications, reported from facilities and pharmacies on a daily basis.
Communicated decision to physicians, physician’s office staff, medical management staff, and/or pharmacists
Communicated selected prior authorization criteria, pharmacy benefit coverage, and formulary alternatives to physicians, physician’s office staff, medical management staff, and/or pharmacists.
Researched, resolved, and documented prior authorization outcomes in the pharmacy system for Medicaid and Medicare Part D patients.
Uses spreadsheets or databases to organize information and produce standard reports
Updated status reports and resolved client issues / disputes.
Escalated requests to Pharmacist when requests required extensive clinical review or denial.
Documented, resolved, and researched physician or client inquiries and grievances.
Provided verbal or written results to client, prescriber, provider, and/or management.
Reviewed daily pharmacy reports for facilities ensuring the proper outcome.
Located ICD-9, ICD-10, CPT, and HCPCS codes to determine the diagnosis of the member.
Prepared invoices for the end of month (ensuring facility and company invoices were all on one accord).
Kept abreast of trends in medical terminology and utilized to perform basic duties.
Responsible for updating status reports and resolving client issues
Researches, resolves, and documents prior authorization outcomes into the pharmacy systems
Communicates selected prior authorization criteria, pharmacy benefit coverage and formulary alternatives to physicians, physician office staff, medical management staff, and/or pharmacists
Pharmacy Technician, CVS Pharmacy, Richmond, VA (PT) Jan 2016 – Feb 2016
Received prescriptions via over the phone, fax or in person, translated and entered prescriptions where permissible and filled medications on a daily basis
Verify eligibility prior to filling medications
Stocked medications upon delivery from the warehouse or vendor
Collected payment via debit, credit, and or check
Provided customer service (over phone and in person)
Resolved financial and operational issues in collaboration with other pharmacy staff
Knowledge of specialty pharmacy products, supplies, medical terminology, and procedures
Informed doctors’ offices when a prior authorization was required via phone and/or fax
Assisted in controlling inventory on a daily and weekly basis
Pharmacy Representative, CVS Caremark Specialty Pharmacy, Raleigh, NC Jan 2014 – Dec 2015
Handled Inbound and Outbound calls. Coordinated and processed new and refill orders.
Assisted with payment posting, verified eligibility and prior authorization, and other reimbursement requirements prior to shipment. Responsible for updating status reports and resolving patient issues.
Worked with both internal and external customers to ensure orders were processed in a timely manner and meet all financial and clinical requirements prior to fulfillment.
Assisted patients with obtaining rebates, co-pay assist programs, and grants for patients that could not afford their medications.
Identified when accounts were past due. Collected payment via debit, credit, and or check by phone using a secure payment system within the company.
Verify eligibility and prior authorization and other reimbursement requirements prior to shipment
Collected payment via debit, credit, and or check by phone using a secure payment system within the company.
Identified, resolved or deferred orders that had accounts receivable or clinical problems.
Sent out letters electronically to patients to inform of any changes and or billing to their accounts.
Assisted in enrolling and tracking the status of new customer referrals and with initiation of therapy.
Sent out letters electronically to patients to inform of any changes and or billing to their accounts.
Resolved financial and operational issues in collaboration with other pharmacy staff, admissions and reimbursement. Provided information and training to new customers.
Escalated clinical questions and issues to the staff pharmacist for resolution.
Translated and entered prescriptions where permissible in CoverMyMeds and Emdeon with Medicaid patients.
Assisted with administrative and operations duties as required.
Knowledge of specialty pharmacy products, supplies and procedures.
Knowledge of Medical Terminology and working with AS400 databases. Performed duties independently.
Pharmacy Precertification Representative (Aetna), Xerox (Temp), Cary, NC Oct 2013 – Jan 2014
Received Inbound calls and faxes from doctor’s office, hospitals, and Long-Term Care facilities requesting prior authorizations for Medicare Part D members. Analyzed data to determine precertification for medications.
Made decisions to approve or deny medications based on Aetna criteria.
Located ICD-9, CPT, and HCPCS codes to determine the diagnosis of the member.
Processed prior authorizations for approve medications and verified eligibility.
Member Service Representative, Sam’s Club, Raleigh, NC (PT) Mar 2013 – Feb 2014
Sold new and existing memberships to customers informing the member of the different types of memberships offered and which ones were best for them. Assisted customers with return and exchanges.
Answered phone calls and customer inquiries about products carried within store and online
Made sure membership desk was in order. Trained new employees. Provided customer service to customers.
Ensured proper store condition by ensuring products were in their correct place.
Managed cash/ ensured cash control by opening and closing the membership desk and making sure all the money was accurate. Knowledgeable in all of the different types of products offered.
Pharmacy Help Desk Representative (CVS Caremark), Xerox (Temp), Raleigh, NC Dec 2012 – Mar 2013
Inbound calls/Provided Pharmacist/Doctor’s offices with assistance in filing a claim for a member.
Helped pharmacist obtain paid claims for members such as providing overrides so members could obtain medication they need. Assisted Pharmacists with questions regarding patient’s insurance information.
Advised pharmacist if the information was not correct on file, that the member needed to call member services and get their information updated.
Assistant Store Manager, Walgreens, Louisburg, NC Mar 2011 – Sept 2012
Managed store employees by giving them tasks to complete by the end of their shift and made sure it was up to standards. Assisted store manager with orientation, training, and other tasks to support store employees.
Provided customer service to customers when it was needed.
Ensured proper store condition by making sure the store was fully stocked with merchandise, there were no out of date merchandise, cleanliness of the store, and overall appearance of the store.
Controlled inventory by reviewing the shrink dash board on a daily basis and assisted the store manager with making decisions on how to manage shrinkage.
Managed cash/ ensured cash control by opening and closing the store day to day and ensuring cash was accurate daily. Processed order reviews for the entire store.
Merchandises products within the store such as: back to school merchandise, Halloween merchandise and Christmas merchandise. Received in vendors and ensured products were in the accurate place.
Assisted customers in photo lab by receiving information, assisting on kiosk machines, printing photographs, and solving any photo lab issues when they arose.
Assembled displays for the store, received in stock on a weekly basis.
Received in invoices, prepared them for outgoing mail and matched invoices/checks.
Assisted the pharmacist with filling prescriptions, entering prescriptions into the work queue, and assisted patients when coming to drop off and pick up prescriptions.
Connection Center Sales Associate, Wal-Mart, Knightdale, NC Jul 2010 - Mar 2011
Established new and existing contract agreements with customers.
Inventoried phones on a daily basis and provided customer service to customers.
Ensured proper store condition by making sure products were in their correct place and price correctly.
Managed a cash register and assisted with selling televisions, digital cameras, prepaid and postpaid cell phones.
Knowledgeable of different phones, plans, and accessories; also trained new employees.
Tax Preparer, Liberty Tax (Internship), Elizabeth City, NC Jan 2009 – Apr 2009
Provides customer service by answering phones and customers inquires.
Prepared Individual tax returns using standard and itemized deductions.
Took refresher courses and maintained cleanliness in the workplace.
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