Service Representative Pharmacy
Resume:
Roberta H Woods
Bloomfield, NJ ***03
Home 973-***-**** Mobile 862-***-****
OBJECTIVE:
Seeking a position that will allow me to effectively utilize current skills and allow for growth within the organization.
SPECIAL SKILLS
IBS processing system (Internal Billing System)
Account adjustments (credits/debits)
Microsoft Excel, Windows 98, and Power Point
Microsoft Word and Basic Knowledge of Access
Pharmacy Service/Customer Service Representative December 1, 2009 10/14/2015
W@H Annie Oakley Drive, Las Vegas, NV
Assisted members with:
Prescription drug plan benefits via telephone (call-center)
· Prescription co-payments deductibles, caps, oops (out of pocket)
· Prescription drug coverage total benefit package such as pharmacy referral and plan limitations
· On-line drug ordering submission
· Clients and member with explanation of benefit packages
Incubated rep for GEHA (Government Employees)
Assisted retail pharmacy with electronic claims submission (via) telephone
Senior Claims Processor/Research & Correspondence –Sept. 1999- Dec.2009
Medco Health Solutions
Responsible for reviewing claim inquiries received through electronic queues and paper request to determine appropriate action needed to successfully resolve issues
Research POS (point of sales) rejections and Direct Reimbursement Claims history. Manually calculate claims for corrected co-pay, deductible and out of pocket prescription expense
Monitored Special Client project(s) such as Government Employee (GEHA)
Pharmacy Service/Customer Service Representative September 1997- September 1999
Medco Health Solutions LLC
399 Jefferson Road, Parsippany, New Jersey
Assisted members with:
Prescription drug plan benefits via telephone (call-center)
· Prescription co-payments deductibles, caps, oops (out of pocket)
· Prescription drug coverage total benefit package such as pharmacy referral and plan limitations
· On-line drug ordering submission
· Clients and member with explanation of benefit packages
Contact members in reference to drug recalls and drug-to-drug interactions after reviewing members updated prescription information
Assisted retail pharmacy with electronic claims submission (via) telephone
Claims Adjudicator/Processor July 1995-September 1999
Paid Prescription/Merck-Medco LLC, 399 Jefferson Road, Parsippany, New Jersey
Processed high dollar claim submission
Assisted supervisors with reviewing claim for accuracy
Trained new employees for Claims Adjudication
Prepared daily statistic reports
Maintain daily files/logs
Reference Available Upon Request
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