Prior Authorization Pharmacy Technician
Resume:
Rebecca Warsaw
Clayton, MO
********@*****.***
· Professional Pharmacy Technician with over 10+ years of experience in prior authorization
· Experienced in accepting requests for prior authorizations via phone and fax and answering inbound calls from doctor's offices and other medical staff
· Proficient at navigating diverse software systems Work Experience
Precertification Specialist
St. Luke's Hospital (MO) - Chesterfield, MO
February 2024 to April 2024
I processed estimates for radiology services using a Patient’s deductible, out-of-patient max, co-pay and co-insurance.
Prior Authorization Specialist/Referral Specialist Centene - St. Louis, MO
February 2020 to November 2023
# Utilize prior authorization submissions received via fax and web portal
# Interface with three distinct software systems to access state-specific information
# Facilitate the prior authorization process for inpatient, outpatient, and urgent care services Certified Pharmacy Technician Prior Authorization Specialist Anthem - St. Louis, MO
February 2019 to August 2019
# Responded to Prior Authorizations calls
# Verified member information and inputs data for the pharmacists
# Educated members on pharmacy-based rules related to prescriptions and medication resources or assistance programs
# Processed prior authorization requests from physicians' offices and ensures compliance with Medicare requirements;
# Informed relevant parties of all prior authorization determinations
# Provided resolution to grievances and appeals issues
# Responded to inquiries from physicians, sales team, and members related to formulary and prescription benefits
Patient Care Coordinator/Pharmacy Technician
Express Scripts - St. Louis, MO
December 2017 to November 2018
· Provided answer to questions related to drug participation program for elderly and low-income patients
· Completed enrollment on behalf of patient
· Educated on next-steps and alternatives programs if rejected Prior Authorization Pharmacy Technician
Magellan Medicaid - St. Louis, MO
January 2010 to October 2017
# Provided assistance in handling prior authorization issues, approvals and denials for physicians and pharmacists
# Responded to criteria questions based on trial/failures for preferred medications
# Reviewed ICD-9 codes/dosing for approvals
# Handled 120+ calls/faxes
# Resolved point-of-sale rejections
# Verified patient information by performing outbound calls as needed
# Experienced in providing great customer service
Education
Bachelor's Degree in Biology
Maryville University
1999
High School Diploma
Parkway Central High School
1995
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