SHEELA THOMAS

**** *********** **** * ***** Prospect, IL 60056 I 847. 269. 9510 (C) adx6xu@r.postjobfree.com

CERTIFIED PHARAMACY TECHNICIAN- PRESCRIPTION ENTRY, READING, INTERPRETING, PRIOR AUTHORIZATION SPECIALIST, CUSTOMER SERVICE.

PROFESSIONAL SUMMARY

Advocate Aurora Lutheran General Hospital-CURRENT

PSR, Cardiology, Parkside center.

Greets and checks in patients arriving for their appointments. Ensures patient information is complete and accurate. Collects patient responsibility as identified in the pre-registration process.

Completes the registration process on walk-in patients, verifies and/or updates patient demographic and insurance information if changes or additions have occurred.

Verifies insurance benefits, obtains/calculates patient responsibility and request payment. Communicates to patient the organization expectation of payment at time of service.

Identifies patients in need of financial assistance and refers patients to Financial Advocate when necessary. Collaborates with Financial Advocate to coordinate patient’s financial resources and responsibilities including requesting patient to sign a Financial Obligation Form (FOF) or Advanced Beneficiary Notice (ABN) as needed.

Monitors patient flow to ensure patients are cared for in the most efficient and courteous manner. Performs visit closure, including checking out patients, collecting additional patient responsibility (when applicable) and providing patient with appropriate documents.

Schedules patient visits using guidelines established within scheduling system.

Assists with new caregiver onboarding.

Works assigned EPIC work queues, following the department’s work flow process.

Maintains excellent public relations with patients, families, and clinical staff as well as demonstrates a willingness and ability to work collaboratively with others for concise and timely flow of information. Proactively communicates issues involving customer service and process improvement opportunities to management.

Maintains knowledge of and reference materials for Medicare, Medicaid and third-party payer requirements, guidelines and policies, insurance plans requiring pre-authorization/referral and a list of current accepted insurance plans.

OMNICARE A CVS COMPANY

FROM 2012-2020, CAME BACK 11/01/2021-6/30/22

OMNICARE, a CVS HEALTH COMPANY, LONG TERM CARE PHARMACY, Des Plaines, IL 60018

Clinical Intervention Center

oPrescription entry, verify prescription information, contact prescriber for incomplete information and verification, Customer Service, Screening orders.

oAssists in package re- calls: inspecting packages/drugs, recording results,

o8 years of managed care or insurance experience, Prior Authorization expert.

o8 years adjudication claims issues, Billing, including Illinois Public Aid experience.

oExcellent communication skills with providers, DON’s, nurses.

oWorked with various insurance companies.

oExcellent communication skills to follow written and verbal instructions, along with ability to understand technical pharmaceutical and medical terminology.

oExcellent communication skills interacting with doctor’s office, patients, and staff in a courteous manner; and to maintain positive working relationship with them.

oStrong customer service background since 1986 from various other jobs.

oGenerated repeat business through successful client follow-up.

oTriage all incoming phone calls and faxes.

oIntake: Verify and process all insurance approved and denied prior authorization forms, verify patient’s benefit coverage, financial responsibility, current insurance plan, Relay insurance coverage and patient responsibility to referral sources, Sales, and patients. Discuss patient responsibility and documentation required for billing of services, update status to approved or denied, if approved, rebill claims, and send to pharmacy to fill the medication.

Work Adjudication claims to meet run times and ensure timely dispensing of medications.

Work with facility staff to gather pertinent clinical information needed to secure overrides/prior authorizations.

Initiate Prior Authorizations as directed by a CIC pharmacist or Clinical Specialist

Fax and electronically submit completed prior authorizations to insurance plans for review.

Call insurance plans to follow-up on submitted prior authorizations and bill claims for backdates.

Communicate to the Supervisor staff and then escalate to the Claims Manager any changes in prior authorization criteria or issues related with various insurance plans and processors.

Work backlog of rejects as appropriate.

Follow all applicable government regulations including HIPAA.

Display behavior which exemplifies employee code of conduct guidelines.

ADVOCATE AURORA LUTHERAN GENERAL HOSPITAL, CENTRAL PHARMACY

Pharmacy technician, Deliver meds, handle control substance accounting, compounding,Deliver medications to each unit, compound, syringes, Med cart, Controlled substance process.

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