Customer Service Technician
Resume:
C laudia O. Taylor
Richmond,Tx 77406
**********@*****.***
SUM MARY
National Certified Pharmacy Technician who is able to communicate with insurance
carriers to obtain payment for prescription claims. Well versed in medical billing, claims,
p rior authorizations and resolving billing issues. Communicates well with pharmacists,
doctors, and patients. Local candidate is available to interview and start immediately.
T ECHN ICAL SKILLS
Proficient with such programs as MS Office, Windows 95, 98, 2000, 2007, ME, XP, Office
97, In tercom Plus and Comp-U-Care, Method Hospital Network System Essentials,
E xtensive Internet Background, Medi-Soft and Care Tracker, General Office Procedures,
Outpatient Care Services
PROFESSIONAL EXPER IENCE
M edia Riders
Xerox Corporation
Pharmacy I ntake (Medicare D) 12/13-
02/14
•Track and triage coverage determination requests submitted from providers and determine if a
pharmacist review is required
•Obtain verbal authorizations and request detailed clinical information from prescribers
•Approve coverage determination requests based on defined criteria within the scope of approved
protocols or decision trees
•Enter and document coverage determination request decision into the PBM system and notify providers
and/or members
•Respond to client inquiries regarding authorization approvals and PBM on-line applications Refer
coverage determination requests for specialty drugs to delegated vendor or client for processing
•Contact providers for additional information to facilitate coverage determination reviews
•Notify physicians, providers and members of coverage determination request decisions
•Communicate with physicians, nurses, pharmacists and patients regarding the coverage determination
and re-determination (appeal) process and decision outcome (favorable and unfavorable) with empathy
and professionalism.
•Independently monitor and manage workflow, and assist pharmacists in maintaining workflow as
required to meet all timeline requirements.
•Analyze online prescription claims and troubleshoot rejections within specific plan parameters.
•Ensure correct application of drug benefit (i.e.: formulary, exceptions, network and co-payments).
•Enter data within web-based workflow management program and manage workflow tasks as required.
•Ability to multi-task within multiple systems and source programs.
•Other duties as assigned.
Food Town Grocery 08/13-
11/2013
C ashier
• Operates cash register to itemize and total customer's purchases in grocery,
department, or other retail store: Reviews price sheets to note price changes and sale
i tems.
• Records prices and departments, subtotals taxable i tems, and totals purchases on
cash register.
• Collects cash, check, or charge payment Counts money in cash drawer at beginning
and end of work shift from customer and make change for cash t ransactions
• Stocks shelves and marks prices on i tems
• Record daily t ransaction amounts from cash register to balance cash drawer
• Weigh i tems, bag merchandise, issue t rading stamps, and redeem food stamps and
p romotional coupons. Cash checks
• Use electronic scanner to record price
Nath Reimbursement
04/12-07/12
Client Services Manager
• Serve as the central point of contact for assigned clients, patients, Data Ent ry and
Accounts Receivable team to resolve claim issues
• Managed paper claims for assigned clients including secondary claims
Acclivity Healthcare
08/11-04/12
PASC/ACS
C ustomer Service/Insurance Follow-Up Specialist
• Received high volume calls regarding medical patient’s hospital and physicians accounts
• Updated insurance and submit ted medical claims to various insurances
• Researched CPT and ICD-9 codes to ensure proper billing
• Researched questionable credit and debits
• Direct contact with physicians and hospitals nationwide
• Held responsible for medical billing/follow up of hospital or physician or DME services
• Translated internal billing documents to appropriate billing forms payer sources and
electronic files
• Reviewed accounts and move balances to the next appropriate payer reviewing and
applying contractual adjustments
• Processed claims using UBO4 and 1500 forms HCPS ICD-9 CPT and EOB's
Scheel’s Pharmacy 06/10-
02/12
Pharmacy Technician
• Assisted patients with prescription orders
• Entered prescription orders into the computer
• Created patient profile
• Communicated with insurance carriers to obtain payment for prescription claims
• Prepared medication and supplies for dispensing
• Coordinated billing including third party prescriptions
• Completed weekly distribution center medication orders and verify all associated
paperwork
• Screened telephone calls for pharmacist.
• Communicated with prescribers and their agents to obtain refill authorizations
• Order supplies and medications for pharmacy
Spherion 09/09-12/10
Client Services/Benefits Specialist
• Answered questions and resolve issues based on inbound calls, emails and internet
i nquiries from members, clients while maintaining consistent quality
• Researched and responded to enrollment issues
• Assisted in the preparation of daily, weekly and monthly reports
• Update member data which includes dependents, change of addresses, and ensuring
data integrity
The Methodist Hospital 03/09-
09/09
Registered/Certified Pharmacy Technician
05/05-02/07
• Prepared pharmacy inventory, order supplies for satellite pharmacies within the
hospital
• Received and delivered medication orders to patient care area
• Prepared IV medications and filled patient medications using Omni Cell
• Created spreadsheets in order to keep t rack of high dollar medications and narcotics
• Developed and maintained an electronic service on all telephone calls with complete
follow-up history for pharmacy call center
• Assisted with internal audits for the pharmacy
• Entered doctor’s orders into the computer using hospital network
• Credited and charged patients for IV and PO medications
• Ran reports and filled pyxis machines
• Responsibilities include Dispensing Machine refill, p reparation of sterile products, charge
verification, prepacking of medications, delivering of medications to units.
Covent ry Healthcare 10/07-03/09
Associate Claims Specialist
• Processed paper claims and electronic work queues, including HCFA 1500 and UB92
• Interpreted and processed adjustments in accordance with company policies and
p rocedures
• Processed claims and adjustments
• Examined information including, but not limited to, authorizations, payments, denials,
coordination of benefits, and eligibility
• Maintained production and claims quality standard
• Interfaced with customers via telephone to respond to routine inquires and resolve
concerns
• Actively followed up and collect on all assigned accounts following established
p rocedures
• Oversaw all appeals for worker’s compensation cases on assigned accounts
Eckerd D rugs
10/01-06/04
Certified Pharmacy Technician
• Assisted patients with prescription orders
• Entered prescription orders into the computer
• Created patient profile
• Communicated with insurance carriers to obtain payment for prescription claims
• Prepared medication and supplies for dispensing
• Screened telephone calls for pharmacist.
• Coordinated billing including third party prescriptions
• Communicate with prescribers and their agents to obtain refill authorizations
Pharmacy Healthcare Solutions 10/2001-2009
Reimbursement Analyst
• Maintain communication with various manufactures and doctors for drug reimbursement
underpayment.
• Tracked and documented cost savings/avoidance. Maintained files and documents of claim
submittal.
• Cataloged existing information from pharmaceutical companies and payers.
• Kept administration informed of significant changes.
• Monitored trends and reasons for denied claims.
• Resolve issues that interfere with reimbursement.
• Maintain a database comprised or receivables, problems and successful responses to
reimbursement.
• Screened reimbursement versus charges for hospital
E DUCAT ION
Texas School of Business
Certified Medical Assistant
L oneStar Community College
Associate Degree (Nursing)
C ERT I F ICAT ION
Certified Pharmacy Technician
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