Resume

Sign in

Pharmacy Technician Customer Service

Location:
Richmond County, NY
Salary:
45000
Posted:
March 21, 2018

Contact this candidate

Resume:

HIBA Q. SYEDA ** Bolivar St

Email: ac4v2g@r.postjobfree.com Staten Island, NY 10314

Cell: 734-***-****

PROFESSIONAL SUMMARY

I want to excel in a stimulating and challenging environment; building the success of the company and helping it surpass its goals using my education and experience as an appeals coordinator. I want to further advance and evolve myself in this role and having an opportunity to be in a position that will help me utilize knowledge, talents and skillset.

SKILLS

Customer Service - Team Building - Leadership -Interpersonal Skills - Microsoft Office - Problem Solving - Medical Terminology -Management Skills -Organizational Skills - Multilingual (English, Urdu, Hindi) - HIPPA compliance - Familiarized with CMS regulations (Prior Authorization and Appeal) - CSRF- Salesforce – AS400 -Servicenow

PROFRESSIONAL EXPERIENCE

Appeals Coordinator December 2016 – Present

OPTUMRx, UnitedHealth Group, Oklahoma City, OK

Regularly review company job aids and work instructions to ensure process accuracy.

Familiar with CMS regulations, CSRF, Salesforce, AS400, and Servicenow

Troubleshoot and respond quickly to appeals questions and problems to provide guidance and manage escalations.

Navigate computer systems to research appeals clinical information

Point of Contact (POC) and validator for both internal and external appeal request.

Provide continuous feedback and assistance on appeal process improvement to internal and external team members

Assist internal teams with subject matter expertise for appeals department

Ensure complaint and quality has been categorized correctly.

Process Part-D, commercial, and Medicaid appeals.

Experience in creating filtering, sorting, data input, editing, saving excel reports (IRO Response Check) for appeal cases.

Designed a Job Aid that managed the streamlining of my divisions production processes and improved Georgia Medicaid appeals fax and email entering and retrieval process in PAS

Prior Authorization Coordinator June 2014 – December 2016

OPTUMRx, UnitedHealth Group, Oklahoma City, OK

Processed fax prescriptions and prior authorization requests.

Contacted patients, pharmacists and doctor's offices to resolve claims issues and customer problems

Familiarized with CMS regulations, ICD-10 coding, guidelines, procedures.

Educated members and providers regarding status on previously submitted Prior Authorization

Handled escalated claims.

Utilized leadership skills by facilitating, consulting team members, troubleshooting, answered complex questions related to this area of expertise and the field where the competency is used, and teaching a new PAS system.

Certified Pharmacy Technician August 2013 – June 2014

CVS Pharmacy, Oklahoma City OK

Pharmacy Technician February 2012 – June 2013

Rite Aid Pharmacy, Livonia MI

EDUCATION/CERTIFICATIONS

MBA, Management, Southeastern Oklahoma State University, Durant, OK March 2017– Present

Anticipated Graduation: August 2018

Principles of Effective Training Delivery Assistant (POET D.A) January 2017

Bachelors of Science, Educational Studies, Walden University, Baltimore, MD February 2013

National Pharmacy Technician Board Certification (NPTB) November 2012

Associate in Science, Schoolcraft College, Livonia MI August 2009

Salem High School, Canton, MI June 2006



Contact this candidate