Prior Authorization Pharmacy Technician
Resume:
******************@*****.***
Hanford, CA 93230
Skills
SKILLS• Records Maintenance
Proficiency in Software:
understanding ed medical
termsInsurance
proceduresMealcal
ferminologyPhysician order
verificationInsurance
VerificationAuthorizationsRetro-
AuthorizationsVala
cnuryKnowledgeable in
SoftwareMedical terminology
knowledgeWorkflow
ManagementEffective
communication skillsMedical
CodingUnderstanding of
insurance details• Prescription
Coordination
Pharmacology• benent
coverageClaim research
Critical thinking abilities
Quality Assurance Practices
Prior Authorization Process
Professionalism and Ethics
Healthcare Regulations
Understanding
Claims processing experience
HIPAA Compliance Knowledge
Patient Confidentiality
Compliance
Clinical Documentation
Improvement
ICD-10 Coding Familiarity
Electronic Health Records
Proficiency
Continuous Improvement
Multitasking
Decision-Making Problem-
Solving
Time management abilities
Attention to Detail
Analytical Skills
Effective Communication
Interpersonal Skills
Analytical Thinking
Application support
Reliability
Goal Setting
Problem-solving abilities
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Hardworking Prior Authorization Specialist with successful background working closely with insurance company representatives to gain preapproval for procedures and testing. Detail-oriented performer with experience of managing documentation. Considered team player with exemplary multitasking skills. Detailed pharmacy technician and prior authorization specialist that is committed to never letting vital requests or documents go unprocessed. Diligent tracker of patient outcomes and caretaker feedback. Incorporates empathetic communications with professional best practices to satisfy plan members and business goals alike.
Patient-oriented Pharmacy Technician with extensive experience preparing, filling and labeling medications. Highly skilled at processing prescriptions and managing pharmacy inventory. Well-versed in interacting with patients to answer questions and provide status updates on prescription fills. Successful Pharmacy Technician bringing 3 years of experience now in filling prescriptions with expert accuracy, building relationships with customers and promoting teamwork within pharmacy settings. Knowledgeable about regulatory guidelines and policies governing fraud, waste and abuse. OptumRx - Prior Authorization Pharmacy Technician
07/2022 - 01/2024
Chris Littlejohn
Summary
Experience
Performed data entry in pharmacy software system to enter prescription orders, patient profiles, and prior authorizations.
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Evaluated non-formulary drugs based on cost effectiveness compared with formulary drugs when necessary during the authorization process.
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Verified patient demographic and insurance information to ensure accuracy of prior authorization requests.
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Assisted pharmacists in preparing medical records for submission to insurance companies for prior authorization approval.
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Analyzed prior authorization request forms to determine appropriate coding before submission.
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Verified insurance benefits to refill medications by examining formularies and calling insurance companies for exceptions.
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Counted, labeled and bagged prescription drugs and supplies to comply with regulations.
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Maintained current knowledge of changes within the healthcare industry related to the prior authorization process.
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Processed incoming faxes for new prescriptions and prior authorization requests.
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Developed strategies aimed at improving overall efficiency in managing the time spent on each step of the prior authorization process.
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Provided customer service support by responding promptly and professionally to inquiries from patients, physicians' offices, insurance companies. via phone or email.
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Conducted follow-up calls with physicians' offices regarding incomplete or missing information on prescriptions.
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Some College (No Degree):
Pharmacy Technology
SJVC
Visalia, CA
Time Management
• Applicant engagement
Teamwork and
CollaborationAdaptability
Eligibility Determination
Telephone Etiquette
Active Listening
Adaptability and Flexibility
Excellent Communication
Muttilasking Abilities
Relationship BuildingResource
informationProfessional
DemeanorProgram
knowledgeTask PrioritizationSelf
MotivationProblem-solving
aptitudeProfessionalismOrganiz
ational Skills
Education And Training
Researched drug formularies as well as therapeutic alternatives when needed during the authorization process.
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Identified potential problems with submitted requests by verifying all information is accurate before sending out for review.
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Reviewed physician's office notes for medication history and allergies to ensure safety of patients.
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Ensured that all required documents were obtained before submitting a request for approval of medications requiring preauthorization.
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Interpreted health plan benefits and coverage requirements related to prior authorization process.
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Contributed to resolving discrepancies between received documentation and the pharmacy software system.
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Assisted pharmacist with clearing high volume of prescriptions and responded to customer questions.
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Created new customer profiles and updated demographics, allergies and new medications in pharmacy computer systems.
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Teamed with peers, technicians and pharmacists to prioritize and complete orders.
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Refilled medications, offered insight into over-the-counter products and verified insurance benefits.
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• Verified prescriptions and drug labels, documents and packages. Interpreted and processed medication orders under supervision of pharmacist.
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• Prepared prescription transfers to other pharmacies. Maintained pharmacological practices by checking drug inventory, stocking medications and monitoring supplies.
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Liaised with pharmacist to measure and prepare medication doses and packaging and label prescriptions.
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Transmitted claims to insurance companies for payment and reconciled EOBs.
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Improved inventory management procedures to reduce overhead, backorders and overstock.
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Flagged potential side effects and allergies to prescribed medications for patients.
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• Answered telephones to respond to questions or requests.
• Entered prescription information into computer databases. Assisted customers by answering questions, locating items or referring to pharmacist for medication information.
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• Operated cash registers to accept payments from customers. Received written prescription or refill requests, verifying information for completeness and accuracy.
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Received written prescriptions and refill requests from patients, evaluating information for completeness and accuracy before filling.
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Cleaned and maintained equipment or work areas according to prescribed methods.
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Greeted customers and answered questions regarding personal medications or over-the-counter pharmacy products.
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• Maintained proper storage and security conditions for drugs. Prepacked bulk medicines, filled bottles with prescribed medications and typed and affixed labels.
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Checked medications for content, accuracy and completeness of drug packaging and labeling.
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• Mixed pharmaceutical preparations according to written prescriptions. Communicated effectively with doctors and insurance agencies to resolve prescription cost discrepancies.
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Walgreens - Retail Pharmacy Technician
Hanford, CA
10/2021 - 06/2023
• Prepared and processed medical insurance claim forms and records.
• Assisted customers with prescription refills and inquiries.
• Provided customer service, answering phone calls and responding to emails. Maintained accurate records of prescriptions filled and medications dispensed.
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Performed data entry for new patient profiles and updated existing patient information.
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• Verified insurance coverage for patients' medications. Stocked shelves with pharmaceuticals, medical supplies and over-the- counter products.
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• Labeled medication containers according to pharmacy regulations.
• Organized inventory in the stockroom according to expiration dates. Greeted customers as they entered the store and provided them with assistance when needed.
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• Processed payments through cash registers or computer systems.
• Completed paperwork related to insurance billing processes. Followed safety protocols while handling hazardous materials such as drugs, chemicals, and cleaning solutions.
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Ensured compliance with state board of pharmacy regulations regarding dispensing of medications.
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• Trained new employees on proper procedures for filling prescriptions. Dispensed prescription drugs per physician instructions in accordance with state laws.
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Managed daily operations within the pharmacy department including stocking shelves, ordering supplies, maintaining cleanliness standards.
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Reconciled drug inventories by comparing physical counts against computer records.
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Educated patients about their prescribed medications including side effects, interactions and dosage directions.
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Assisted pharmacist with clearing high volume of prescriptions and responded to customer questions.
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Teamed with peers, technicians and pharmacists to prioritize and complete orders.
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Created new customer profiles and updated demographics, allergies and new medications in pharmacy computer systems.
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Refilled medications, offered insight into over-the-counter products and verified insurance benefits.
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Interpreted and processed medication orders under supervision of pharmacist.
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Received and verified daily incoming drug inventories, reported discrepancies and logged items into inventory system.
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Maintained pharmacological practices by checking drug inventory, stocking medications and monitoring supplies.
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• Verified prescriptions and drug labels, documents and packages. Inspected medication storage locations to monitor drug expiration dates and supply adequate inventory.
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Liaised with pharmacist to measure and prepare medication doses and packaging and label prescriptions.
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• Prepared prescription transfers to other pharmacies.
• Transmitted claims to insurance companies for payment and reconciled EOBs.
Improved inventory management procedures to reduce overhead, backorders and overstock.
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Leveraged database to confirm validity of prescriptions, patient data and drug side effects.
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• Answered telephones to respond to questions or requests.
• Entered prescription information into computer databases. Assisted customers by answering questions, locating items or referring to pharmacist for medication information.
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Received written prescriptions and refill requests from patients, evaluating information for completeness and accuracy before filling.
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• Operated cash registers to accept payments from customers. Received written prescription or refill requests, verifying information for completeness and accuracy.
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Greeted customers and answered questions regarding personal medications or over-the-counter pharmacy products.
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Cleaned and maintained equipment or work areas according to prescribed methods.
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Ordered, labeled and counted stock of medications and entered inventory data into computer.
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Checked medications for content, accuracy and completeness of drug packaging and labeling.
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• Maintained proper storage and security conditions for drugs. Received and stored incoming supplies and informed supervisors of stock needs and shortages.
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Communicated effectively with doctors and insurance agencies to resolve prescription cost discrepancies.
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• Established or maintained medications and other patient profiles.
• Mixed pharmaceutical preparations according to written prescriptions.
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