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Dr. Sarah J. Koskei

Doctor of Pharmacy, Pharmacist

*** ********* **

Chadds Ford PA 19317

484-***-****

admyf2@r.postjobfree.com

Sarah J Koskei

Summary:

· An accomplished Pharmacist over 18 years of experience in Managed Care and Retail Pharmacy with special emphasis on Prior Authorization, Pharmacovigilance, and Medical Information.

. Promotes patient centered model of care, interpersonal skills and team development, guided by empathy, kindness and consideration of welfare of others

· Expert in medication review cases and Handling Medicare Part D prior authorization reviews.

· Skilled in serving as a clinical resource to the Prior Authorization staff in reviewing denied, unclear or questionable Prior Authorization requests.

· Strong experience in supporting efforts on enhancing customer experience by increasing focus on healthcare services such as patient consultation, medication management, drug therapy reviews, and perform retail, clinical, or wellness services.

· Hands on experience in performing pharmacist tasks including compounding, drug therapy reviews, verification, and medication management, interpreting and accurately dispensing prescribed medications pursuant to workload.

· Followed-up with medical providers’ offices to clarify prescribed medications, dosages, refills, interactions and allergies to suggest alternative medications, and answered medical provider questions.

· Experience in ensuring the accurate processing of insurance claims to resolve customer issues and prevent payment rejections.

· Proficient in Microsoft Excel, Word, PowerPoint and great Customer Service Skills.

Skills:

. Oriented to clinical pharmacy outcomes

. Promote team and individual development

. Strong teaching and coaching skills

. Team player and promotes inclusivity

· Prior – Authorization.

· Drug Utilization Review.

· Medicaid and Medicare.

· HIPAA.

· Medication Therapy Management

· Strong Clinical Background.

· Drug therapy reviews

· FDA drug Safety guidelines.

· Excel

· Word

· Microsoft

· Typing

· Phone

· Compounding

· Hospital

· MTM

· Access

. Remote work capability

Education:

· Doctor of Pharmacy University of Sciences Philadelphia

Bachelors of Science Biochemistry

Started Masters of Public Health Program

Certifications/Licenses:

· Pharmacist Sep 2020 – Sep 2022 (active, renewed every 2 years)

Resident Producer Individual Life and Fixed Annuities, Accident and Health

Experience:

AmeriHealth Caritas – PA

Sep 2018 – May 2021

Reviewed prior authorizations and medical necessity requests for pharmacy and physicians based on established pharmacy guidelines and contract criteria. Applied critical clinical judgment, updated treatment guidelines and standards in Compendia in the review process. Processed denials to appropriate queue for medical review. Systematically generated notification letters to members and physicians on approved and denied requests.

Handled calls and correspondence from providers and internal call center regarding inquiries, complaints and reconsiderations of prior authorizations. Documented calls in inquiry tracking system to ensure accuracy and concise reporting.

Maintained work ethics and guidelines that support Fraud and Abuse program system oversight. Communicated any suspected fraud discovered by the contact center staff.

Worked in conjunction with internal staff supervisors to ensure internal changes that affected network services are reflected in the claims processing system.

Responded to telephone inquiries from physicians, other healthcare professionals and internal call center select drug information.

Maintained knowledge of industry trends and regulatory changes in the pharmacy industry and evaluated their effect on pharmacy contracts and services.

Continued to perform other related duties and projects as assigned. Attended required training on an annual basis.

Walgreens – PA

Jan 2001 – Mar 2018

Pharmacist/Prior-Authorization

·Consulted with customers regarding the effective usage of medications, drug interactions, offered immunizations.

·Ensured the proper compounding, dispensation, reviewed and verified prescribed medications following guidelines.

·Maintained workflow of the pharmacy, assisted in optimization pharmacy, inventory management and enhanced customer experience.

·Performed coverage determination for prescription drugs against established criteria on any prior authorization requests.

·Prior authorization medication review cases / speaking with Physicians and Nurse on a constant basis to approve and /or deny medications for a member.

·Demonstrated pharmacy knowledge, drug utilization review, and excellent consultation skills to customer service.

·Participated and collaborated with the clinical pharmacist team discussion CMS regulatory issues, company policies and other projects as needed.

·Handled Medicare Part D prior authorization reviews.

·Reviewed and accurately interpreted physician’s orders by checking judgment based on patient’s medication history.

· Provided clinical knowledge to Physicians and making clinical judgment based on patient’s medication history.

· Engaged customers and patients by being personable, acknowledged and greeted them, offered assistance with products and services.

· Serve as a clinical resource to the Prior Authorization staff in reviewing denied, unclear or questionable Prior Authorization requests.

· Communicate Prior Authorization /appeal requirements to healthcare providers as requested.

· Assist the Prior Authorization managers and supervisors in the daily operations of the Prior Authorization department including the planning and implementation of new client Prior Authorization programs.

· Educate Prior Authorization staff on client or Catamaran specific Prior Authorization guidelines and processes.

· Assist in training activities for internal/external candidates entering the clinical call center

· Other activities as determined by the Prior Authorization Manager

· Resolved customer issues in a timely manner and answered questions to ensure a positive customer experience.

· Modeled and shared customer service best practices with all team members to deliver a distinctive and delightful customer experience, including interpersonal habits such as greeting, eye contact, courteous service traits that included offering help proactively, identifying needs, servicing until satisfied.

· Developed strong relationships with most valuable customers by anticipating customer needs and proactively offered services.

· Supported efforts on enhancing customer experience by increasing focus on healthcare services such as patient consultation, medication management, drug therapy reviews, and perform retail, clinical, or wellness services such as immunizations, flu shots, and diabetes awareness, promoted the shift of the pharmacy role from transactional to interpersonal.

· Participated and assisted in community events such as immunization clinics.

· Counseled and answered patient’s questions regarding usage of medicine, side effects, interactions, contraindications, patient information privacy, generics, less expensive medicines, over-the-counter products, and refers to medical provider as needed to ensure medication is taken correctly, health needs addressed, and satisfaction with service.

· Performed pharmacist tasks including compounding, drug therapy reviews, verification, and medication management. Reviewed, interpreted and accurately dispensed prescribed medications pursuant to workload.

· Ensured the pharmacy operated in accordance to regulations, company policies and standards.

· Maintained procedures that promoted the efficient workflow of the pharmacy.

· Responsible for the opening and closing of the pharmacy and shift change duties.

· Ensured the use of all elements of the Good Faith Dispensing policy in conjunction with state and federal controlled substance laws when filling prescriptions.

· Maintained ultimate responsibility for ensuring that the elements of Good Faith we're adhered to.

· Maintained knowledge of information technology to provide support to customers as well as pharmacy staff. Implemented enhancements to pharmacy systems to further promote productivity.

· Ensured the accurate processing of insurance claims to resolve customer issues and prevent payment rejections.

· Followed-up with insurance companies as well as medical providers and participates in 3rd party audit.

· Followed-up with medical providers’ offices to clarify prescribed medications, dosages, refills, interactions and allergies to suggest alternative medications, and answered medical provider questions.

· Performed retail, clinical, and wellness services such as immunizations, flu shots, diabetes awareness and other preventive healthcare services.

· Analyzed performance key indicators for self-development, customer service, and implementation of procedures for pharmacy asset protection and inventory management.

· Developed and maintained good relationships with local medical community including physicians, nurses, and other health care providers.

· Participated in community outreach activities to promote the pharmacy business and further enhance growth opportunities.

· Assisted in training of pharmacy personnel.

· Promoted teamwork and motivated team members,

· Maintained current knowledge and skills related to pharmacy and healthcare by reading pharmacy related journals, company publications, and communications.

· Maintained awareness of developments in retail and management and pursued best practices that would enhance performance.

· Obtained necessary certifications, education credits and training.

· Sought professional development and shared relevant corporate health and wellness services or strategy information to pharmacy staff.

References:

1.Moa Biftu, Prior Authorization Supervisor, AmeriHealth Caritas, admyf2@r.postjobfree.com

2.Niju Varughese, Prior Authorization Supervisor, AmeriHealth Caritas, admyf2@r.postjobfree.com

3.Andy Dang, Clinical Prior Authorization Pharmacist, AmeriHealth Caritas, admyf2@r.postjobfree.com

(Phone numbers available upon request)

Contact this candidate