DARILYNN J. STEVENS

***** ******** ***** **. • MARYLAND HEIGHTS, MO. 63043

PHONE 314-***-**** • E-MAIL • ac352b@r.postjobfree.com

OBJECTIVE:

To seek employment of a permanent position in the pharmacy industry that will utilize my expertise and enhance my special abilities and training that I have acquired.

LICENSE:

Missouri Pharmacy Technician 2001

CERTIFICATION:

Pharmacy Technician Certification Board 2011

PROFESSIONAL EXPERIENCE:

United Scripts St. Louis, MO 01/15 – Present

Billing and Claims Adjudication Senior Technician

Assist hospital staff pharmacist in the preparation and dispensation of medications to the patients undergoing inpatient treatment.

Evaluate and process claims in accordance with company policies and procedures. Adjudicate secondary payers if applicable.

Apply medical necessity guidelines, determine coverage, complete eligibility verification, identify discrepancies

Proof claim or referral submissions to determine, review, or apply appropriate guidelines, coding, member identification processes, provider selection processes, claim coding, including diagnosis.

Check for erroneous items or codes and missing information and correct according to established procedures.

Review and analyze data from system-generated reports for in-process claims in order to identify and resolve errors prior to final adjudication.

Troubleshoot and resolve rejected claims.

Alert manager to claims aging issues as well as provider billing problems.

Maintains current knowledge of commercial, Medicare and Medicaid insurances.

Maintains current knowledge of each state’s specific guidelines, rules and regulations.

Maintains knowledge of policies/procedures as well as industry standards for claims adjudication.

St. Louis University Hospital St. Louis, MO 02/15 – 07/16

Senior Pharmacy Technician CPhT

Assist hospital staff pharmacist in the preparation and dispensation of medications to the patients undergoing inpatient treatment.

Refill Pyxis machine using ParRX; emptied the narcotic bins. Responds to on demand STAT doses and first doses orders.

Checked Epic for medication messages, dispense doses, missing medications, home medications and appropriately credits patients for unused and discontinued medications.

Use standardized recipes to create compounded medications like ointments for topical application, or elixirs Boston butt cream, hog enema, magic mouthwash etc.

Prepare Crash cart, cold boxes, and RSI kits.

Receive and stock supplies and confirm quantities against invoices.

Prepares IV admixture, IV piggybacks, TPN’s

Performs other duties as required. Assist other pharmacy technicians;

Magellan Health Services St. Louis, MO 09/10 – 02/15

Clinical Pharmacy Technician CPhT

Evaluated and authorized approval of prior authorization pharmacy requests from prescribers received by telephone and/or facsimile using client clinical criteria.

Determined appropriateness for medications. Communicated decision to physicians, physician’s office staff, medical management staff and/or pharmacists. Researched, resolved and documented prior authorization outcomes in pharmacy system.

Communicated selected prior authorization criteria, pharmacy benefit coverage and formulary alternatives to physicians, physician’s office staff, medical management staff and/or pharmacists.

Escalated requests to Pharmacist when request requires extensive clinical review or denial.

Researched, resolved and documented physician or client inquiries and grievances and provides verbal or written results to client, prescriber, provider and/or management.

Performs other duties as required. Assist other pharmacy technicians;

BJC Missouri Baptist Hospital St. Louis, MO 08/08 – 09/10

Pharmacy Technician CPhT

Entered prescription orders; Created and updated patient’s health and insurance information in the computer

Communicated with insurance carriers to obtain payment for prescription claims.

At point of sale, verified that customer received correct prescription(s);

Completed weekly distribution center medication orders, placed orders on shelves, and verified all associated paperwork;

Assisted the pharmacist with filling and labeling prescriptions; Prepared the pharmacy inventory;

Screened telephone calls for the pharmacist; Assisted other pharmacy technicians;

Communicated with prescribers and their agents to obtain refill authorization;

Express Scripts Inc. Maryland Heights, MO 11/02 – 07/06

Pharmacy Technician, Insurance Claims Representative

Prepared and verified new prescription and refill orders. Selected and retrieved appropriate medications, compound and dispensed medical prescriptions, verify quantities, and prepare labels for bottles.

Pre packed medications from manufacture’s bottles to use in dispensing medication in the ‘quick pick’ areas. Prepare medications for shipment. Received and stored incoming medications and counted stock. Replenish workstation supplies. Vary work duties according to business need.

Received patient and physician calls for registrations of patients into program, verified insurance benefits, obtained authorizations

Tracked patient activity for refill prescriptions and shipment of products on monthly basis

SKILLS:

Typing (52 wpm), Pharmacy, Inpatient Pharmacy, Outpatient Pharmacy, Retail Pharmacy, Mail Order Pharmacy, Long Term Care Pharmacy, Epic, CPR Plus, QS1, PioneerRX, DocuTrax, FrameWork, CoverMyMeds, Medical Terminology, Cash Handling, Insurance Verifier, Medical Billing, Insurance Claims, Missouri Medicaid, Illinois Medicaid, Data Entry, ICD9, ICD10, Fraud & Waste Abuse, NDC, Therapeutic Classes, Microsoft Office; Word, Excel, PowerPoint, Access, WordPerfect, Internet, Microsoft Windows, Management, 10-Key, Administrative, Communication, Payment Processing, Billing, Collections, Customer Service (10+ years)

EDUCATION:

Sanford Brown College St. Louis, MO 10/02 – 08/04

Associate Degree/ Paralegal Studies

Family Law, Litigation Support, Legal Research & Writing, Legal Terminology, Wills & Estates

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