*** ******** *****, ******* *******, PA ***** 610-***-**** / adu3ra@r.postjobfree.com

Michelle Passio

Objective To obtain a position that will enable me to use my strong organizational skills, clinical knowledge background, and ability to work well with people.

Experience

July 2014 - Present

PerformRx, Philadelphia, PA

Pharmacy Prior Authorization Technician II

Would be considered a dedicated subject matter experts for multiple lines of business

Assist with process questions from the Prior Authorization Technician I team related to their dedicated line of business

Assist with Appeals processing

Identifies problems in process/procedures or services and makes recommendations for improvements. Responsible for reviewing and approving physician or member inquiries for pre-authorization and medical necessity requests based on established pharmacy guidelines and contract criteria.

Responsible for understanding and applying clinical criteria for processing Prior Authorization requests in a timely manner.

Responsible for receiving prior authorization requests telephonically while utilizing multiple systems to confirm accuracy of the information being provided.

Supports Fraud and Abuse program system oversight by reviewing medication utilization records. Communicates any suspected fraud discovered. Recommends course of action for providers where patterns appears outside of guidelines and generally accepted pharmacy standards.

Maintains a balance of productivity, quality and timeliness of job accountabilities.

Participates in department self-audit procedures for on-going evaluation of service.

Creates and supports an environment which fosters teamwork, cooperation, respect and diversity. Establishes and maintains positive communication and professional demeanor with internal and external business partners at all times.

Strong knowledge in non-specialty pharmaceuticals

Ability to adapt to a high pace changing environment.

Strong interpersonal, written and oral communication skills.

Attention to detail and ability to follow instructions.

Attends required training on an annual basis.

Strong knowledge in specialty and non-specialty pharmaceuticals

Must be available to work weekends and holidays.

Performs other related duties as assigned.

July 2008 - September 2013

Family Chiropractic Wellness Center

Prospect Park, PA

Office Manager / Physician Assistant

Attention to Detail

Patient Care for patient heat and electric stem therapy

Billing Patient Insurance plans

Prior Authorization coverage for X-Rays/MRI procedures

Patient check-in and check-out

Scheduling patients

January 2008 - July 2008

Stat Care Family Medical-

Clifton Heights, PA

Front Desk Coordinator

Assistant To Physician

Attention to Detail

Education

2013 to April 2014

Penn Foster Career School

Scranton, PA

PTCB Certification

License #10090154

Pharmacy Tech Program

Penn Foster Career School Scranton, PA

August 2013 – April 2014

Paralegal Accounting

The PJA School - Upper Darby, PA

2006 to 2007

Dental Assistant

Thompson Institute - Philadelphia, PA

2004 to 2006

References

References are available upon request.

Contact this candidate