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Customer Service Insurance

Pittsburgh, Pennsylvania, United States
February 06, 2018

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*** ********* ****, ********, ** ****6 C: 412-***-****

PA-Licensed pharmacist with over 20 years experience in Drug Utilization Review, Medicare Part D and insurance prior authorization, specialty pharmacy, cost effective therapies, patient counseling and education, accuracy and efficiency.

Ability to quickly identify and prioritize potential problems and formulate solutions

Accuracy and efficiency

Understands importance of efficient workflow

Medicare Part D prior authorization

Excellent verbal and written communication skills

Works well independently or on a team

Patient counseling and education

Clinical Pharmacist, 11/2015 to 07/2016

CVS Caremark, RIDC Park – Pittsburgh, Pennsylvania Focus on Medicare Part D and insurance prior authorization Review drug coverage determination and appeals for Medicare beneficiaries ensuring timely decisions Participate in Medicare Stars performance to contribute to 5 star excellence Review quantity limits, step care edits, dose and duration edits Navigate efficiently between resources to verify diagnosis Communicate with physician offices advising on formulary changes to ensure no interruption in therapy Provide clinical review and decisions to physician and member appeals Clinical Pharmacist, 04/2015 to 11/2015

Millennium Pharmacy Systems – Cranberry Township, PA A focus on patients in nursing, long term and assisted living facilities Produce cost effective therapies by utilizing therapeutic interchangeable protocols Screen patient's medical records and profiles for allergies, drug interactions and therapeutic duplications Perform medication reconciliation for new admissions as close as possible to time of admission Oversee transitional care




Maintain records for controlled substances

Verify order entries and technician preparation and labeling of pharmaceuticals Specialty Clinical Pharmacist, 05/2014 to 04/2015

Accredo Health Group – Wexford, PA

A focus on patients with Pulmonary Arterial Hypertension Offer extensive counseling and education to patients Calculate dosing for injectable medications such as Flolan, Remodulin and Veletri Coordinate Adempas titration with patient and home health care nurse Effectively communicate with prescribers and patients to ensure compliance and optimum care Ensure both patients and physicians adhere to the REMS program when applicable Clinical Pharmacist, 05/2009 to 04/2014

Express Scripts – North Versailles, PA

A focus on patients with prescription mail order benefits Screen medications for allergies or sensitivities to inactive ingredients such as coloring agents, fillers, diluents, preservatives, flavorings and sweeteners Educate patients and physicians on Warfarin dosing with regards to pharmacogenetic testing results of CYP2C9 and VKORC1 alleles

Advise physician's office of drug backorders and suggest substitutions Verify accuracy of prescription orders as entered by technicians Owner and Pharmacist, 05/2000 to 01/2009

The Medicine Shoppe® Pharmacy – Carnegie, PA

Built business from ground up

Created a marketing plan and promotions to grow and expand business Counsel patients on medications including administration, storage, side effects and potential interactions Resolve customer issues in a timely manner and answer questions leading to a positive customer experience Accurate and efficient processing of insurance claims Community involvement and dedication

Pharmacist in Charge, 04/1994 to 05/2000

CVS – Aliquippa, PA

Oversee operations of the pharmacy department

Strong focus on customer service, quality and accuracy Counsel patients on proper use and adverse effects of medications Monitor storage, distribution, and use of pharmaceuticals Ensure compliance with laws and regulations

Assist patients with selection of OTC medication

Establish procedures that promote an efficient workflow Accurate and efficient processing of insurance claims Bachelor of Science: Pharmacy, 1991

University of Pittsburgh School of Pharmacy - Pittsburgh, PA EDUCATION

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