Pharmacy Technician Prior Authorization
Resume:
MICHAEL IBENEME, Associate Degree (Sciences)
************@*****.***
EDUCATION
****- **** ******** *******, ****** TX Associate Degree, Sciences
LICENSURE AND/OR CERTIFICATIONS
2007 Certified Pharmacy Technician
2007 Registered Pharmacy Technician
2012 Associate Degree
2023 Life insurance
PROFESSIONAL EXPERIENCE
ZEMORA CONSULTING, LLC
355 VISTA GLEN DR, PLANO TX 75074
08/01/2023 – DATE
Job Title Customer Care Rep. (CERTIFIED PHARMACY TECHNICIAN)
Duties & Responsibilities Call Center Role
Interact with customers to resolve complaints, which involves:
Taking calls from customers and triaging to relevant teams
Processing customers’ orders
Providing information about the organization's products and services
Managing patient information within the computer system
Escalate unresolved issues to relevant internal teams
Collect accurate feedback from customers directed at improving company services
ELEVANCE HEALTH (ANTHEM, Inc.)
04/2022 – 09/2023
Job Title Customer Care Rep. (CERTIFIED PHARMACY TECHNICIAN)
Duties & Responsibilities MEDICARE PART D AND PRIOR AUTHORIZATION
Medicare Part D
Processing prescription claims for Medicare Part D beneficiaries, involving:
Verifying prescription details
Checking eligibility for Medicare Part D plans
Submitting claims to the pharmacy benefit manager (PBM) for processing
Managing patient information within the Part D system
Patient Interaction
Assisting with adherence initiatives by contacting patients regarding refills and potential cost-saving options
Discuss medication adherence; identifying factors that limit adherence and offering practical, helpful solutions
Answer questions regarding their Part D coverage
Prior Authorization
Confirming if a prescription requires prior authorization from the patient's insurance plan
Notify the Patient of the need for Prior Authorization, and therewith secure Patient’s consent
Notify doctor’s office that billing claims for a prescription has been declined by the patient’s insurance and Prior Authorization is required, and that Patient has been notified
Verify with doctor’s office whether the doctor wants to pursue Prior Authorization or prescribe an alternative medication
Verifies whether doctor’s office needs help to submit the Prior Authorization and if that is the case, send form to doctor’s office requesting Patient’s clinical information needed for the Prior Authorization
Notify the Patient when the Prior Authorization has been submitted and subsequently inform Patient about the outcome of Prior Authorization request, whether approval or denial
With approval, re-run Patient’s insurance claim and complete the processing of patient’s prescription
PHONE-FACING ROLES
Outbound And Inbound Calls
Calls are generated to patients who have failed to fill their prescription at their local pharmacies for a specified period of time
Questions are asked to identify non-compliance issues
Solutions are provided to resolve identified non-compliance issues, which include:
i.Calling the doctor's office on behalf of the patient to obtain refills or new prescription
ii.Calling Patient's local pharmacy to secure refills for the patients
iii.Referring or reaching out to Patients Health Maintenance Organization (HMO) to help patient secure a provider within their network
iv.Other activities directed at lowering health cost to the Patient and encouraging compliance
ALTO PHARMACY, 475 TX-121 Suite # 150, Lewisville, TX 75067
06/2021 – 11/2021 (Contract)
Job Title Customer Care Rep. (CERTIFIED PHARMACY TECHNICIAN)
Duties & Responsibilities
Prior Authorization
Call and notify the Patient about insurance rejection and the need for Prior Authorization, and therewith secure Patient’s consent
Notify doctor’s office that billing claims for a prescription has been declined by the patient’s insurance and Prior Authorization is required, and that Patient has been notified
Verify with doctor’s office whether the doctor wants to pursue Prior Authorization or prescribe an alternative medication
Verifies whether doctor’s office needs help to submit the Prior Authorization and if that is the case, send form to doctor’s office requesting Patient’s clinical information needed for the Prior Authorization
Notify the Patient when the Prior Authorization has been submitted and subsequently with the outcome of Prior Authorization, whether approval or denial
With approval, re-run Patient’s insurance claim and complete the processing of patient’s prescription
Billing
Patients’ insurance data are collected including the type of coverage (primary, secondary), BIN number, PCN number, Group number and member ID. Important billing information is inputted such as: Prescriber information with DEA and NPI number (national provider identifier number); Patients’ insurance is billed to obtain copay cost of the prescription and if there is a rejection, troubleshooting of claims that are rejected due to • Non covered medication, requiring Prior Authorization • Incorrect days’ supply • Refill too soon • Invalid quantity • Incorrect insurance information etc.
Patient discount or coupons, if available are applied to further reduce cost of medications.
If the rejected claims require prior authorization, work with doctors’ offices to submit Prior authorization requests to insurance companies
Phone-facing Roles
Receive calls from patients seeking information on the status of their prescription; PHIs are confirmed, and Patient’s prescription profile accessed. Actions during calls usually involve insurance billing to provide copay information, placing order for refills, resolving of delivery issues and other actions required to solve the patients’ problem
Make outbound calls to patients to resolve prescription-related issues
Make and receive incoming calls from doctors’ offices and insurance companies
Intake of Prescription
Prescriptions sent by prescribers are crosschecked to ensure that they contain all the relevant information like the prescriber's name, address, telephone number, the prescriber's DEA number, if the order is for a controlled substance etc.; while medical abbreviations are translated and calculations performed to ensure that the proper quantity is being dispensed.
ALLIANCERX WALGREENS PRIME SPECIALTY PHARMACY
10530 John W. Elliot Dr, Ste. 100
09/2019 – 03/2020 (Contract)
Job Title Customer Care Rep. (CERTIFIED PHARMACY TECHNICIAN)
Duties & Responsibilities
Make calls to Doctors’ offices to clarify written prescription orders in order to ensure timely processing, dispensing and delivery of life-saving medications/therapies.
Make calls to patients to verify completion of therapies and communicate information from Doctor’s offices in matters affecting the processing of their ordered medications, in order to meet Patient’s expectations.
Work with my team of Pharmacy Technicians and Pharmacists as a cohesive unit, and with little or no supervision in a high-volume, fast-paced work-flow environment to efficiently coordinate the processing, dispensing and delivery of ordered prescriptions.
TEXAS HEALTH PRESBYTERIAN HOSPITAL, DALLAS
8200 Walnut Hill Ln, Dallas, TX 75231
03/2009 – 05/2012
Job Title Certified Pharmacy Technician
Duties & Responsibilities
Processing of medications using Omni-cell automated system
Delivery of medications to hospital floors
Operation of the Pyxis machine, Omni-cell drug stock maintenance operations
Monitoring drugs for deterioration and expiration dates
Filling of prescriptions; production of labels from available prescription information, labeling products correctly, including cautionary and auxiliary labels, inputting patients’ data and medication orders into a computer system
Prepares medications including suspensions, ointments and emulsions, takes inventory, places order, checks in drugs and supplies from manufacturers, stocks shelves and remove expired items from the inventory
Communicates with patients and doctors in a pleasant and professional manner
Processes medications returned from the facility floors for credits as necessary
MGS PHARMACY, LANCASTER
2502 West Beltline Rd., 75146, TX
Job Title Certified Pharmacy Technician
Duties & Responsibilities
Locate, count, pour, and package prescribed medications for patients
Prepare labels for medications
Read prescriptions and medication orders to prepare medications for dispensing
Call patients to indicate ready prescriptions and communicate with insurance, nurses and doctors’ offices
Calculate the quantities of medication to dispense
Record and file prescriptions and physicians' orders
Help pharmacists process insurance claims
Track inventory levels and alert pharmacists when stock needs to be replenished
Help pharmacists file paperwork
Ensure the pharmacy workspace is organized and stocked with the necessary supplies and equipment
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