Authorization Specialist Prior
Resume:
Tammy Ritchey
Certified pharmacy technician, Subject Matter Expert for Insurance Reimbursement and Prior Authorizations, billing and configuring specialist. *************@*****.***
Work Experience
Shields Health Solutions
Patient Support Advocate
February 2022 to Present
Job Duties:
Directly communicate with insurance companies to facilitate the approval of medications Navigate pharmacy operating systems to input data, perform adjudication on test claims and prepare action plans for follow-up. Assist patients in the management of their pharmacy insurance claims Work closely with pharmacists and pharmacy liaisons to provide an integrated approach quality patient care.
McKesson
Account Coordinator
May 2021 to February 2022
Account coordinator for Mckesson/ CoverMyMeds. Assisting providers, payers, and pharmacies with starting, fixing, and completing Prior Authorizations of biologic medications. Accredo Specialty Pharmacy
Pharmacy Technician
October 2020 to March 2021
Option Care Health
March 2020 to October 2020
Pharmacy Technician II
Infusion Pharmacy for patients with hydration issues to terminal illnesses. Processed weekly and monthly shipments for patients infusion medications and supplies. Processed lab results for patients and data entered them into patients profiles. Worked closely with the Pharmacists to verify prescriptions, and process faxes to Dr's offices for refill requests. Scanned all prescription order paperwork from our onsite pharmacy. Trained and helped out as a compounding technician. Prior Authorization Specialist
Oscar Health - Tempe, AZ
November 2019 to March 2020
Prior Authorization: performed prior Authorizations to Oscars patients Insurance reimbursement Specialist
Diplomat Specialty Pharmacy - Chandler, AZ
September 2018 to November 2019
Worked as an Insurance Reimbursement Specialist and Prior authorization Specialist. Helped doctors offices, insurance companies, patients get the proper Prior authorization information and/or helped submit prior authorizations for doctors. Performed trouble shooting within our system Scriptmed, any insurance and adjudication errors.
Pharmacy Technician/benefits specialist
Pinnacle Health - Tempe, AZ
October 2017 to September 2018 Help diabetic patients with benefits, coordinating shipments/payments and getting a proper prescriptionif needed for all testing supplies. Make outbound calls for follow up on shipments, customer service, andany technical questions needed answered. Prior Authorization Specialist
UnitedHealth Group
February 2016 to October 2017
Take incoming calls from Dr's offices and pharmacies, members, processing prior authorizations for meds, worked on Georgia Medicaid faxes and calls, processing appeals, compounds, TPN's,also process cancels and pending faxes.
Prior Authorization Specialist care management
Blue Cross Blue Shield -
August 2015 to February 2016
Took incoming calls from doctors, also initiated prior authorizations by faxed in requests. Verify if CPT codes require authorization. Call hospitals for discharge dates of inpatient stays. Billing configuration coordinator
Magellan - Scottsdale, AZ
October 2014 to August 2015
Responsibilities Testing new client insurance builds. Update client based changes. Utilize AS400 and transition to First RX all and any new clients or coding issues. Configuration of benefits to get paid claims per the data base. Skills Used Learning and adapting quickly to a new configuration system. Was trained on billing and coding of revised and new client plans. Prior Authorization Specialist pharmacy technician Aetna - Phoenix, AZ
June 2014 to November 2014
Responsibilities Take inbound calls from doctors’ offices, member services, pharmacies helping with prior authorization inquiries, rejections, etc. Data entry of fax and called in prior authorization requests. Enter approvals and denials based on pharmacist determination. Accomplishments Took calls in a timely matter, achieving resolutions to problems, rejections, explanation of benefits, overrides for specific situations. Skills Used Being a certified pharmacy technician helped get answers for customers and doctor inquiries on formulary and non formulary alternatives. Education
Phoenix College in Pharmacy
Phoenix College - Phoenix, AZ
March 2010 to June 2010
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