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Customer Service Prior Authorization

Location:
Cordova, TN
Posted:
January 07, 2023

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Resume:

Career Summary

Patient service-oriented pharmacist with a Doctor of Pharmacy degree. Strong background in specialty clinical pharmacy and complex medication management, mail order, and retail pharmacy. Eager to join a company where I can generate dynamic results through my experience, to contribute to the development of a profitable client relationship. Passionate about working with patients and seeking to expand pharmaceutical knowledge base and enhance clinical skills.

Summary of Qualifications

Clinical/Retail Pharmacist with eighteen years of experience providing consultative services to healthcare professionals, manufacturers, and patients; documenting clinical activities and outcomes; and providing prescribed medication according to professional standard practices while following appropriate policy and procedures. Additional skills include:

Clinical interventions

Drug Utilization Reviews

Ensure compliance with HIPAA privacy regulations

Strong organizational skills

Manage prior authorization process /Insurance claims/Sales process

Experience in identifying and reporting adverse events and product complaints into every level of interaction

Adhere to FDA drug safety guidelines

Supervise and train pharmacy technicians and customer service representatives

Experience

2020-present Axion Healthcare/United Healthcare Memphis, TN

Staff Pharmacist

Responsible for assessment, education, clinical management and follow-up of adults with diabetes and hypertension, in a managed care environment

Provide close management of blood pressure, blood glucose, and Hemoglobin A1c levels for patients

Provide diabetes and hypertension self-management education and support for patients

Interact with patients to understand side-effects of medication as well as new health issues, and recommending exercise routines, and modifications in diet as required

Assist in weight loss management program for overweight patients and high blood sugar levels to reduce the risk of stroke, kidney failure, or other related ailment

Make 100 to 150 calls per day counseling patients

2008-2020 Accredo Specialty Pharmacy/Cigna Health Memphis, TN

Staff Pharmacist

Trained in endocrinology, immunology, rheumatoid arthritis, growth hormone, multiple sclerosis, fertility, movement/neurological disorders, oncology, and infectious disease

Engaged in provision of pharmaceuticals and prescriptions to individuals with health issues parallel to the indications of designated product line

Expertly skilled in providing education pertaining to medications and disease state management for patients and healthcare professionals

Oversee and participate in the training activities for pharmacists, pharmacy technicians, and customer service representatives

Executed clinical assessments of laboratory tests and patient characteristics to individualize medication treatment plan

Assessed incoming and outgoing medications to insure proper identification, strength, purity, and instructional requirements

Participated in adherence to good pharmacovigilance practices with timely regulatory screening and reporting of adverse events and product complaints to manufacturers

Performed prior authorization process including collecting all the necessary documentation, contacting the client for additional information and completion of the required prior authorization in order to proceed with approval or denial process

Completed, timely, and accurate identification and submission of prior and retro authorization requests to payors

Effectively documented patient and claim account activity to prevent issues resulting in delayed claims processing

2007-2008 Omnicare Memphis, TN

Staff Pharmacist

Provided clinical support to long-term care facilities and hospital pharmacies

Maintained inventory at pharmacy and placed orders in time

Worked closely with the clinical team and contributed in the quality improvement process

Checked new orders, do refilling, and check processed orders

Analyzed effectiveness of drug and determined their choice in preparing medications

Took active role in improving evidence-based medication management

Maintained privacy of patient medical information

Managed pharmacy technicians and customer service representatives

2004-2007 Schnucks Pharmacy Memphis, TN

Staff Pharmacist

Advised physicians, nurses, etc. on issues concerning drug therapy, the inherent toxicity of drugs, side effects, and assisted with appropriate dosages

Handled and dispensed prescription drug orders

Conducted and evaluated medication histories, assessed compliance and suggest modifications to achieve desired outcomes

Counseled and instructed patients in the proper use of prescribed and over-the counter drugs

Managed inventory control, expired drugs, record keeping third party processing, and cash handling

Managed pharmacy technicians and customer service representatives

1997-2004 Walgreens Pharmacy Memphis, TN

Staff Pharmacist /Intern/Pharmacy Technician

Advised physicians, nurses, etc. on issues concerning drug therapy, the inherent toxicity of drugs, side effects, and assisted with appropriate dosages

Handled and dispensed prescription drug orders

Conducted and evaluated medication histories, assessed compliance and suggest modifications to achieve desired outcomes

Processed prescriptions rapidly averaging up to 750 prescriptions daily

Counseled and instructed patients in the proper use of prescribed and over-the counter drugs

Managed inventory control, expired drugs, record keeping third party processing, and cash handling

Managed pharmacy technicians and customer service representatives

Education

1998-2002 University of TN College of Pharmacy Memphis, TN Doctor of Pharmacy

1994-1998 Tougaloo College Jackson, MS Bachelor of Biology

License

State Pharmacist License No. 12214 valid until July 2024

Immunization delivery certified since 1999



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