Aizen Ravenholm

Cell: 773-***-****; Email: adsj5w@r.postjobfree.com

Pharmacy Technician / Referral Coordinator

Abstract

A former pharmacy technician with nine years of experience in the health-care industry now seeking a new position to grow a company’s productivity while continuing to improve personal skills and competency.

Excellent written and verbal communication skills. An organized, detail-oriented, and conscientious self-starter capable of strategically prioritizing effectively to accomplish multiple tasks while staying calm under pressure.

Already has a solid understanding of pharmacy operations with about 7 years of experience in a pharmacy benefit manager environment. In addition, has almost 2 years of experience in the accounts receivable position while on project with Script Pro, LLC and has familiarity with implementation processes. Has had prior pharmacy tech certification and speaks two languages fluently – English and Polish.

Understands urgency and complexity of various therapies and services in a specialty pharmacy environment. Would like to continue on a career path in the field of pharmacy and payer/client relations.

Career Progression

AbbVie, North Chicago, IL April 27, 2021 to Present

Insurance Analyst II

Provide subject matter expertise and best-in-class customer service for all inbound and outbound customer calls to drive first call resolution. Provide insurance coverage, verification details prior authorization statues and alternate funding options for existing and newly launched products. Provide offices with current plan forms, portals, and websites for prior authorizations and appeal submissions. Clearly communicate and educate customers on results of the investigation

Investigate and problem solve for patients experiencing escalated issues such as disadvantaged or complex access, savings card/copay card challenges or non-preferred formulary issues. Where necessary, complete a benefit investigation, contact the HCP and/or patient or potentially the filling pharmacy or payor.

Quickly learn and execute business process and system changes for all drugs and channel sources as applicable. Maintain an understanding of current business procedures, deviations, and case processing for all brands and channel sources for Insurance Specialist I role to support as needed.

Documents information in the appropriate system of record and formats. Accurately communicate insurance details to HCP and patients via phone, other electronic communication methods and fax, as per established policies and procedures.

Identify potential Adverse Event situations for reporting to Pharmacovigilance ensuring AbbVie meets FDA regulations.

Support changing business priorities by being flexible in executing or overseeing completion of specific tasks to support the patients, products, or services we provide for all current and new products.

Work cross-functionally to identify and share opportunities for process and productivity improvements.

Successfully complete role based training requirements, including passing certifications and competency assessments prior to conclusion of training period

Meet or exceed department standards relative to performance metrics.

Maintain a work environment that upholds privacy standards required by law and AbbVie policy

Act as a resource for the Training department including providing support for training curriculum and new hires. Provide side by side coaching and assistance for Insurance Specialist Level 1s.

Understand and comply with all required training, including adherence to federal, state, and local laws, SPII policies and guidelines, and the policies and procedures of AbbVie Access Support and AbbVie. Perform additional tasks, activities, and projects as deemed necessary by management.

Provide subject matter expertise on medical and prescription insurance coverage/ verification, claim billing, medication prior authorization and appeal filing, and alternate financial assistance opportunities.

Accurately documents information in the appropriate systems and formats.

Communicate the status of the referral to the physician and the patient via phone, fax, and/or the core pharmacy system as per established policies and procedures.

Assist offices through the entire documentation and filing process for prior authorizations and appeals.

Monitor the status to ensure a rapid turnaround resulting in the procurement of the drug product for the patient.

Use internal and web tools and communicate and collaborate with health insurance payors and providers to investigate pharmacy and medical benefits.

Obtain and confirm information to maintain Pharmacy Solutions’ payor intelligence resources.

Meet or exceed department standards relative to performance metrics.

Take responsibility and accountability for the day-to-day execution of tasks and is responsible for providing periodic progress reports on goals and metrics.

Work cross-functionally to identify and share opportunities for process and productivity improvement and to troubleshoot and/or resolve situations, taking ownership as needed.

Decide whether to reinvestigate or accept obtained benefit verification based on reasonableness and accuracy.

Determine whether to escalate issues/concerns to management for review, guidance, and resolution.

Participate in quality monitoring and in identifying and reporting quality issues.

Enter patient demographic and health insurance information into the hub information system and notify the physician of any incomplete or incorrect insurance information.

Understand and comply with all required training, including adherence to federal, state, and local pharmacy laws, HIPAA policies and guidelines, and the policies and procedures of Pharmacy Solutions and AbbVie.

Identifies potential Adverse Event situations for reporting to Pharmacovigilance ensuring AbbVie meets FDA regulations.

Completes all required training and performs all functions in the position e.g., Soft Skills certification, product and disease overviews.

Perform additional tasks, activities, and projects as deemed necessary by management.

AbbVie, North Chicago, IL February 8, 2021 to April 2021

Insurance Analyst I

Provide subject matter expertise on medical and prescription insurance coverage/ verification, claim billing, medication prior authorization and appeal filing, and alternate financial assistance opportunities.

Accurately documents information in the appropriate systems and formats.

Communicate the status of the referral to the physician and the patient via phone, fax, and/or the core pharmacy system as per established policies and procedures.

Assist offices through the entire documentation and filing process for prior authorizations and appeals.

Monitor the status to ensure a rapid turnaround resulting in the procurement of the drug product for the patient.

Use internal and web tools and communicate and collaborate with health insurance payors and providers to investigate pharmacy and medical benefits.

Obtain and confirm information to maintain Pharmacy Solutions’ payor intelligence resources.

Meet or exceed department standards relative to performance metrics.

Take responsibility and accountability for the day-to-day execution of tasks and is responsible for providing periodic progress reports on goals and metrics.

Work cross-functionally to identify and share opportunities for process and productivity improvement and to troubleshoot and/or resolve situations, taking ownership as needed.

Decide whether to reinvestigate or accept obtained benefit verification based on reasonableness and accuracy.

Determine whether to escalate issues/concerns to management for review, guidance, and resolution.

Participate in quality monitoring and in identifying and reporting quality issues.

Enter patient demographic and health insurance information into the hub information system and notify the physician of any incomplete or incorrect insurance information.

Understand and comply with all required training, including adherence to federal, state, and local pharmacy laws, HIPAA policies and guidelines, and the policies and procedures of Pharmacy Solutions and AbbVie.

Identifies potential Adverse Event situations for reporting to Pharmacovigilance ensuring AbbVie meets FDA regulations.

Completes all required training and performs all functions in the position e.g., Soft Skills certification, product and disease overviews.

Perform additional tasks, activities, and projects as deemed necessary by management.

ScriptPro LLC [TPMS Division], MISSION, KS May 28, 2019 to June 8, 2020

A/R Implementation Representative

Account Management - Handled 5 to 15 new on-boarding client accounts at any given time to manage and facilitate the implementation process of the proprietary TPMS (Third Party Management Systems) solution.

Reconciliation of claim data - present any nuances to clients after bulk of implementation is completed.

Data compiling and liability analysis of “problem” carriers, then relaying this data back to client to maximize bottom-line.

Deep dive analysis of pharmacy claim data fed into the TPMS solution to derive any deviations of adherence against contracted rates and reported findings back to client.

Expected weekly and daily routines performed for each client to ensure business needs are met.

Preparing reports that outline possible missing or overlooked deposits based on open e835 files.

Following up with clients on a daily basis on outstanding items via email or voice.

Working with senior team to ensure implementation of bank feeds; ensuring proper integration of client dispensing systems with TPMS solution reviewing 820 specs for discrepancies.

Daily Skype/Cisco web-ex calls with clients, the senior team and department director - reviewing outstanding items and facilitating implementation processes.

Assisting junior team members when the need arose.

Managing sFTP (secure file transfer protocols) for assigned clients.

oProviding 835 pass-back files for any special case requests.

Orsini Pharmaceutical Services Inc, ELK GROVE VILLAGE, IL July 2018 to November 2018

Admissions Representative

Entering/Updating Insurance and Benefits into pharmacy systems.

Performed Profit and loss risk analysis per case basis to determine most profitable margins between medical and pharmacy benefits.

Benefit verification of both prescription and medical benefits including but not limited to Medicare, Medicaid, VA, federal, commercial and MCOs

Accountable for monthly reverification checks on all Enzyme Replacement Therapy (ERT) clients.

Cross trained in both specialty and infused therapies.

Organizing daily tasks via excel reports of monthly refills based on priority

Accountability for initiating prior authorizations for new onboarding clients and ensuring single case agreements(SCAs) and letters of agreement (LOAs) were filed when needed as contract issues arise.

CVS SPECIALTY PHARMACY, Mount Prospect, IL December 2016 to July 2018

Benefits Verification Representative II

Entering/Updating Insurance for clients.

Coordination of Benefits (COB) for both commercial and federally funded insurance plans including Med D.

Coordinating flow of Prior Authorizations between clients and providers.

Operating pharmacy computer systems software – CATS, HBS/SPARCS, Peoplesafe, Emdeon, CAS, CaseTrakker Dynamo, CE2000, AS400, and Mail Order L.I.N.K.S.

Analysis and data entry of inbound prescriptions.

Work on new referral work flow and patient enrollment into pharmacy systems.

Cross-trained for pharmacy operations on most therapies (Fertility, IVIG, PAH, Chemo, RA, MS)

Working in coordination with direct supervisor and pharmacist to make ensure proper turnaround time.

CVS SPECIALTY PHARMACY, Mount Prospect, IL November 2014 to December 2016

Patient Services Representative II

Entering/Updating Insurance for clients.

Enter co-pay assistance information for customers.

Operating pharmacy computer systems.

Pharmacy/Insurance diversion resolution.

Customer/Patient Support – Outbound/ Inbound Calls.

Working under direct supervision of pharmacists to ensure quality assurance.

Resolve billing or clinical issue on patient orders.

Help patients with translating and entering in new or refill prescriptions into the pharmacy information system.

Communicating and collecting co pay amounts.

Coordination and process new patient medication orders and reorders, which includes verifying benefits.

WALGREENS, Park Ridge, IL December 2012 to November 2014

Photo Specialist / Pharmacy Tech

Performed day-to-day store operation tasks in a retail environment.

Operated photo equipment and managed the photo department.

Performed Pharmacy Technician tasks in the pharmacy during peak hours.

Performed customer service functions in the photo department – Returns / Exchanges

Back end operations – Logistics and stock room management.

Cashier and certain shift lead functions.

PIER 1 IMPORTS., Niles, IL November 2009 – January 2010

Stock Clerk

Handled inbound product distribution – unpacking merchandise.

Helped with setting up store displays for products.

Stock room organization of product bays.

Customer services both on phone and store floor.

POLISH-AMERICAN VIDEO RENTAL, Chicago, IL July 2007 – August 2008

Co-Owner / Manager

Managed building operations.

Key holder of business.

Customer Relations.

Financial Management.

Point-Of-Sale

Technology Proficiencies

Enterprise-level Applications:

Microsoft SharePoint, CATS, HBS/SPARCS, Peoplesafe, Emdeon, CAS, CE2000, AS400, and Mail Order L.I.N.K.S., EPIC, Salesforce / CRM’s

Operating Systems/ Software:

Windows and Mac Operating Systems, Microsoft Office, Adobe Photoshop, Adobe Illustrator, Dreamweaver, Maxon Cinema 4D, Eclipse Java Editor

Education and Certifications

DEPAUL UNIVERSITY, Chicago, IL

Ongoing - Bachelors of Science, Computer Science

WILBUR WRIGHT COMMUNITY COLLEGE, Chicago, IL

Associates of Sciences in General Studies

OAKTON COMMUNITY COLLEGE, Chicago, IL

Pharmacy Technician Certification Program

Contact this candidate