Pharmacy Tech Prior Authorization
Resume:
JENNIFER C ROBLES
SAN ANTONIO, TX 78237
● ******************@*****.***
Work History
ÇVS pharmacy
Pharmacy Tech II
I worked closely with providers to process prior authorization (PA) and drug benefit exception requests for multiple clients or lines of business and in accordance with Medicare Part D CMS Regulations. Must apply information provided through multiple channels to the plan criteria defined through work instruction. Research and conduct outreach via phone to requesting providers to obtain additional information to process coverage requests and complete all necessary actions to close cases. Responsible for research and correction of any issues found in the overall process. Phone assistance is required to initiate and/or resolve coverage requests. Escalate issues to Coverage Determinations and Appeals Learning Advocates and management team as needed. Must maintain compliance at all times with CMS and department standards. schedule flexibility and additional cross training to learn all lines of business. Flexibility for movement to different parts of the business to support volume where needed I was responsible for utilizing multiple software systems to complete Medicare appeals case reviews Meeting or exceeding government mandated timelines Complying with turnaround time, productivity and quality standards Conveying resolution to beneficiary or provider via direct communication and professional correspondence
Acquiring and maintaining basic knowledge of relevant and changing Med D guidance, system used was MHK, Teams, Citrix, Med compass, five 9, verint, RX claim, people safe, outlook United Healthcare
11/2015 to 05/2023
CSR Benefit Specialists SR
Gave Benefit details handled Medicaid and Medicare Claims, appeals, handled customer complaints
Home care Dimensions, SAN ANTONIO, Texas
INTAKE SPECIALIST
Nov 09, 2015 - Jul 06, 2018
Knowledge of applicable DME equipment and processes
Completes all order and entry functions
Demonstrates excellent customer service skills
Produces efficient and accurate orders
Records and updates patient charts accurately, communicating changes to all involved staff
Seeks out solution to conflicts directly through parties involved and other available resources.
Adds pertinent information and documents into the patient record in Brightree Navigate through patient medical records
Arrange for interpreter services when appropriate
Completes insurance verification
Transfer of equipment/inventory
Answers and responds to telephones calls
Takes and leaves concise messages for patients; responds as requested
Completes clerical duties
Reviews and routes scans, faxes medical documents to necessary parties
Report professional development to supervisor
Meet weekly productivity measurements
Implements department procedures to maintain systems and records
Maintains databases, files and records on a regular basis according to established procedure
Cover different DME showroom as needed
Demonstrates strong communication skills
Strong knowledge and familiarity with all systems
Strong organizational and prioritization skills
Ability to prioritize competing activities
Request IT service independently
Kristin Story Held, MD, SAN ANTONIO, Texas
Front Office Medical Assistant
Jun 28, 2012 - Nov 06, 2015
Schedule and enter patients on moms system, EMR systems, and Emma, Answering Multi-line telephone system, faxing,Triage,Greet patients and visitors,Obtain insurance information and personal information from patients as needed,,Making appointments, take messages, transfer calls taking copays, coinsurance and deductible amounts, end of day balancing, provide change as needed,Schedule and cancel appointments,Create new patient records,Monitor and replenish supplies,File patient records,verify insurances, do prior authorizations, and referrals,ICD-9 & CPT code knowlege. Other duties as required. Able to take direction
A Amazing Healthcare, SAN ANTONIO, Texas
Healthcare Provider
Nov 09, 2011 - Mar 20, 2013
Provided Medical reminders, Assistance with care of hair, teeth, dentures, and shaving, trimming nails, excluding clients who are diabetic or have poor circulation, the basic personal hygiene, and grooming needs. Supervising client when performing the tasks, assisting client when caring for own appearance.
v Supervising and guiding client when client is dressing and undressing, assisting with difficult tasks such as tying shoes and buttoning, and completely dressing or undressing consumer when unable to participate in dressing or undressing self. v Supervising consumer able to bathe self when guided, assisting consumer with difficult tasks such as getting in or out of the tub or washing back, completely bathing the consumer if totally unable to wash self. Include giving the consumer a bed bath when bathing in the tub is not a feasible alternative.
v Includes supervising assistance with difficult tasks such as cutting food or buttering bread, and feeding the consumer when unable to feed self.v Supervising the consumer when able to care for own toileting needs if guided, helping consumer to and from the bathroom, assisting with bedpan routines, diapering and lifting client on and off the toilet. v Supervising the consumer when walking alone or with the help of a mechanical device such as a walker if guided. Assisting with difficult parts of walking such a climbing stairs, supervision the consumer if the consumer is able to propel a wheelchair if guided, pushing the wheelchair, and providing constant physical assistance to the consumer if totally unable to walk alone or with mechanical device LINCARE INC, San Antonio, Texas
CSR
Nov 23, 2010 - May 15, 2012
Handles patient, referral source and administrative department inquires. Sets up records of patient information into computer, Answers all incoming calls as the main responder is usually the first contact for referral sources. makes determination of required action. takes orders, from physician's office or other referral sources, enters orders and comments into the CIS. determines all required equipment and enters into CIS. Coordinates new patient delivery schedule with service area and notes in CIS, Processes patient information on a series of forms where accuracy and timely processing is most important. Maintains and files patient information on a regular basis, Verifies insurance coverage and advises collections department of required actions about billing, Process unit dose, renewal reports, and held sales reports by contacting customers, providers, physicians offices and reviewing with regional accounting office, Obtains Medicaid Title XIX's and Medicare CMN's, Handles mail and outgoing courier packages for the center including responding to request for information from internal sources when possible, filled in for service tech in emergencies and was available for on call on weekends and evenings, other duties were assigned
APRIA HEALTHCARE INC, San Antonio
Customer Service Representative
Nov 02, 2009 - Jul 02, 2010
DME Equipment order entry, insurance verification, medicaid, medicare,Title XIX, ICD-9, CPT codeing & billing. Multi-line telephone, fax and EDI inquiries; orders from referral sources and homecare patients; diagnostic codes,
Documents referral request for coordination of care. Provides information on equipment supplies and services. May assist walk-in patients with the selection of equipment, supplies and services. Demonstrates professional etiquette and courtesy when interfacing with customers. Resolves patient/customer complaints by identifying problems and coordinating appropriate corrective action.
Assesses patient needs and promotes company products and services. Complies with and adheres to all regulatory compliance areas, policies and procedures and "best practices".
Other related duties as directed by supervisor.
Took weekend call
Corestaff, Texas
Human Resources Assistant
Apr 01, 2009 - Nov 23, 2009
Set up clients for testing & Interviews with recruiter, Answered phones, placed clients in jobs, Assisted with application process and drug hire kits, filing, assisted with payroll, set up pay cards, graded tests
Kinectic Concepts Inc., Texas
Administrative Assistant
Jun 30, 2008 - Nov 15, 2008
Coordinate department moves, issue new badges for new hires, Order office supplies, Ergonomic supplies and furniture, Book conference rooms, Update AMAG/MDI Badge system for terminiated team members, Update contingent workers access in the data base, Responsible for all calls coming through mulit-phone line switchboard, greeting clients and visitors, Assisted HR with applicants, drug hire kits, electronic resumes, Assisted the Research team in NCC with filing, updating information in HERO, Assisted with sponsored functions, Authorize return for credit to internal customers, Assisted in 3rd party billing, prepared all billing documentation to our KCI service center, Handled all end of the month billing reports, Assisted in trouble shooting minor problems, huddled appointments and set up meetings for managers
U.T. Health Science Center, San Antonio, Texas
Administrative Assistant
Mar 01, 2008 - Jun 30, 2008
Open Mailboxes daily, distribute mail, filing, labels for files, make coffee, copies, prepare check log, login Dr's RTA's in spread sheet, Check paper supply in fax and xerox machines, remove expired conference/seminar fliers from bulletin board, put up next weeks fliers, check paper & supply cabinets, Order to replenish as needed, water plants as needed, take inventory of kitchen and all supplies, Make Travel arrangements, make conference room meeting schedules, Check Dr's Monthly account payables vouchers, Experience using MS Word, Excel, Access, Outlook, 10-Key, Adobe-Scanning documents,Temp Assignment with Express Personnel
R&M Tax Center, San Antonio, Texas
Income Tax Specialist
Dec 05, 2007 - May 30, 2008
Data Entry, filing, prepare and file income tax W-2's, 1099, etc, deposits, answer phones, Strong customer service (part time evening job)
Helen Thompson Media, San Antonio, Texas
Data Entry clerk
Oct 05, 2006 - May 21, 2007
billing invoice entry, mail sort, trafficking, contacting reps for missing invoices, general office support
Roger Christian & Co., San Antonio, Texas
Administrative assistant/Receptionist
Jun 07, 2006 - May 21, 2007
Switch board operator, billing entry, typing filing, Handled all Incoming & Outgoing mail,10-key, Ms Word Ms Excel
E-Z Money loan Co., San Antonio, Texas
Customer Service Rep./Loan officer
Jun 02, 2005 - Jan 30, 2006
Front desk service, Data entry, payment posting, collections, process loan applications, Answer phones, strong customer service
University Hospital, San Antonio, Texas
Medical Secretary
Jul 01, 1995 - Jul 01, 2003
Data Entry, Billing, Coding, filing, Answered multi phone lines, Medical terminology, Assisted RN, Cutomer service, 10 Key, Pt Scheduling, Insurance verification, collected co-pays, Worked in different departments Out patient surgery, Operating room, trained new employees, releived clerks for lunch
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