Prior Authorization Patient Care

Brian Loehr

Open to In-office Hybrid Remote in Portland, OR/SW Washington

************@*****.*** 971-***-**** linkedin.com/in/brian-loehr-0347301 Areas of Expertise:

● Conduct benefit investigations and complete prior authorizations.

● Requested and loaded PBM and/or Major Medical plans.

● Resolved questions and problems submitted by customers and Pharmacy Benefit Manager (PBM) followed established guidelines and standard SOPs and procedures. Utilizes all available information to choose the best solution for customers.

● I processed all non-clinical PBM rejections which may include but not limited to rejections for plan limits, coverage termination or prior authorization.

● Assisted physicians in the prior authorization process, including initiation of prior authorizations.

● Cross-trained and worked on Major Medical (MM) and Specialized PBM Plans.

● Verified benefits for Major Medical are available via online resources or over the phone. Confirmed network status and prior authorization requirements to ensure claim payment.

● Documented contact interactions, recorded details, complaints, comments, and action taken.

● Managed Pharma requirements, including but not limited to warm transfers, bridge/quick start, enhanced prior authorization and appeals.

Professional Experience:

Patient Care Manager (Temporary Contract)

November 2024-April 2025

Populas Group (IQVIA)

● Answered inbound calls, addressed patient inquiries, and provided guidance on pharmacy-related services.

● Contacted insurance companies to investigate coverage eligibility, benefits, and copay assistance options.

● Prepared and completed prior authorizations, ensuring attention to detail and accuracy, coordinated with clinical pharmacists for review.

● Facilitated the patients’ access to medications, managed financial barriers and provided valuable support throughout the patients’ journey. Unemployed

June 2024-November 2024

● I took time off to better myself and complete technical training and certification. Patient Care Coordinator (Contract)

Robert Half Staffing (Walgreens Specialty Pharmacy) August 2018 – August 2019

Insurance Verification Specialist III-Remote

Walgreens Specialty Pharmacy

August 2019 – June 2024

● Loaded PBM and/or major medical plans using insurance portals and ScriptMed.

● Updated customer interactions, recorded details, and action taken in the Windshield Compliance system.

● Utilized MS Windows to verify PBM and/or major medical plans.

● Effectively communicated with Patient Care Coordinators (PCC) to ensure on-time medication delivery and updating new insurance in ScriptMed.

● Applied Genesys (Call Manager) to maintain After Call Work, and documenting disease states.

Home Clerk

Fred Meyer

November 2017 – August 2018

● Stocked shelves, store recovery, and provided exceptional customer service. Education:

June 2024-November 2024

LearnKey-Comp TIA Certification

● Networking Fundamentals

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