Center Representative Prior Authorization

Jason Duel

480-***-**** **********@*****.***

Phoenix, AZ, 85044 www.linkedin.com/in/jason-duel

PRIOR AUTHORIZATION COORDINATOR

Analytical and detail oriented Prior Authorization Representative with extensive experience connecting patients and healthcare providers to vital resources. Proven track record executing prescribed medical funding guidelines and policies. Known for knowledge of medical codes and relevant software, teamwork, accuracy, attention to details, computer competences, and fostering compassionate and sympathetic relations with consumers. Adept at balancing business interests with human-centric service models.

AREAS OF EXPERTISE

Medical Coding Patient Scheduling Authorizations Prescription Coordination Pharmacology

Benefit Coverage Training and Development Teamwork

EXPERIENCE

MedImpact Healthcare Systems Inc., Phoenix, AZ October 2009 – May 2022

Prior Authorization Coordinator III

Verified eligibility and compliance with authorization requirements for service providers.

Adjudicated Authorization Determinations with a 98% average quality accuracy, having affected over 180,000 lives.

Performed over 1000 HIPAA Audits regarding possible breaches of customer privacy; oversaw implementation of updated training to ensure fewer breaches.

Created Workflow and Guideline Instructions streamlining our processes and allowing quicker onboarding of new staff; new hires went from requiring two weeks of one-on-one training to three days on average.

Managed Daily Team Workflow to ensure timely completion of cases in accordance with the Performance Guarantee; prevented at least 100 contract breaches.

Ran monthly small group training sessions as well as daily mentoring PAC staff; updating training with new information to ensure more effective communication.

Uses communications skills as well as knowledge of Microsoft Word, Excel, SQL, and Outlook to create staggard Workflows with reminders to ensure employees engaged with required tasks when needed.

Coordinated with clients regarding various issues, including nuances of pharmaceutical law, billing issues, system irregularities, and clarifying procedures.

Wrote over 15 training guides and updated 60 plan specific PACIPs (Prior Authorization Coordinator Information Packets), allowing staff to more efficiently obtain information; average error rate improved from 96% to 99%.

Received Praise on Multiple Occasions from Clients, including receiving flowers, gifts, birthday cards, and individual calls to Upper Management praising performance.

Individually handled and conferenced with Client Representatives in order to ensure easy implementation of needs; personally settled at least 12 ongoing issues due to misunderstandings or mishandled communication.

Coordinated with Pharmacist staff to arrange training sessions regarding Pharmacology with new or inexperienced PACs to better assist with continuing education or licensing certification.

Walgreens Mail Order Pharmacy, Tempe, AZ June 2006 – May 2008

Outbound Call Center Representative

Contacted customers regarding high dollar amounts due to lack of insurance or high copays incurred with claims billing. Confirmed prescription information from physician's offices regarding clarifying prescription information.

Arranged or rescheduled payment with customers regarding high dollar pharmacy claims; ensured $60 million in confirmed payments over tenure.

Arranged Mail Services for customers in inclement weather; handled over 1,000 cases for victims of Hurricane Katrina and arranged delivery of medication to new addresses.

Jason Duel **********@*****.*** Page Two

CERTIFICATIONS

Licensed Certified Pharmacy Technician 2005 - 2022

TECHNICAL SKILLS

MS Office, MS Excel, Salesforce, HTML Coding, SQL

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