Pharmacy Technician Medical
Resume:
Roshelle Johnson
Frisco Texas 75035
adkea6@r.postjobfree.com
Summary of Skills
Claims Adjudication Excel Split billing
Hospital Billing Framework Medical Collections
Pharmacy J-Codes Account Receivable Claims Submission
Root Cause Analysis ICD-10 codes CreditCard payments
UB04 codes Vision Encode Invoices
Hospice Billing HCFA/Passport Commercial Payers
Docutrak HCPCS codes Insurance Verification
Trained Supervised Outlook/Kronos
Epic Advance Claim Claim Source
Medical Terminology IDX/PDX Champs
Microsoft Word AS400/ADP Availity
Work Experience:
Cantex Continuing Care Network June 2018-Current
Pharmacy Business Office Specialist
●Successfully reviews claims for accuracy, performs required edits, split billing, submits claims and bills to payors daily in electronic format to ensure accurate and timely filing of claims and prompt payment
●Receives and posts assigned payment batches to the appropriate patient account or facility account from checks or remittance advice using appropriate payment and adjustment code to ensure accurate and timely posting of receipts and encode account receivable invoices into docutrack
●Ensures patients are registered in Pharmacy patient accounting system and billed with appropriate payor type and collect credit/debit card payments on individual accounts, and process prior authorizations
Lash Group (contract thru Kelly Services), Frisco Texas May2017-May2018
Reimbursement Counselor
●Researched medical and pharmacy benefits in detail specific specialty drug(Nuplazid) to assist with chronic diseases
●Relayed and follow up on prior authorizations, denials and appeals
●Referred patients to non-profit foundations for assistance with medical expenses
Sonexus Health (contract thru Medix Staffing), Lewisville Texas January2016-April2016
Benefits Investigator/Pharmacy Case Manager
●Effectively managed patient cases for a drug named XelJanz and issued approvals or denials to customer depending on financial income criteria
●Performed/relayed insurance benefits verification outcome to provider offices
●Captured HIPPA authorization and ensured regulations are enforced
●Used diagnosis ICD-10 codes for treatment verification
Roshelle Johnson page 2
Conifer Health Solutions (Contract thru Healthcare Scouts), Frisco Texas July2015-November2015
Account Receivable Follow up Representative
●Prepared and edited medical claims for submission, both hardcopy and electronically to various third party payers and clearing house
●Investigated chargebacks via root cause analysis and resolved with customer or internal business units
●Verified and performed adjustments of payments in the system of advance claims
●Hospital billing for government and commercial payers and collection follow ups
Convergent, Irving Texas May2014-July2015
Patient Access Representative/Workers Compensation Biller
●Promptly follow up with insurance payers on denials and submitted claims
●Precisely completed appropriate claims paperwork documentation and system entry
●Actively maintained current working knowledge of CPT and ICD-10 coding principles, government regulation protocols and third party requirements regarding billing
●Submitted electronic claims documentation for timely filing
Caremark (contract thru GLC Group), Richardson Texas November2013-February2014
Prior Authorization Representative/Certified Pharmacy Technician
●Handled incoming and outgoing calls from physician offices
●Triaged phone calls to appropriate department when needed
●Approved coverage determination requests based on defined criteria
●Entered information accurately into the computer system
Kmart Pharmacy (part-time), Middleburg Hts Ohio October2010-August2011
Certified Pharmacy Technician
●Processed third party pharmacy claims to commercial and government payers
●Assisted in training of new hires and co-op students
●Familiarity with medical and pharmacology, abbreviations, and computer technology
●Four years of retail experience and one year in Long term care pharmacy
Education:
Cleveland State University, Cleveland Ohio 1998
Business Administration in Management Labor Relations
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