Medical Customer Service Specialist with Pharmacy Experience

JOSEPH HOLLAND

(M)813-***-**** ***********@*****.*** 606 South Betty Ln – Clearwater, FL 33756

CUSTOMER SERVICE REPRESENTATIVE

Compliance • Medical Customer Service • Account Management • Call Center Support • Customer CarePharmacy Customer Service • Escalations • Customer Retention • Training Supervisor CAREER HISTORY

WellCare Inc. Tampa, FL 2014 - Present

Pharmacy Technician

Receiving and responding to calls from physician offices and pharmacies, providing information and relaying protocol for approvals.

Entering pharmacy overrides into the WHI system based on approval guidelines and approvals from Clinical Pharmacists.

Responding to a variety of requests from member services and managing other issues as needed to ensure quality customer service.

Reviewing member profiles for the 4 brand limit, generating letters to physicians with recommendations for changing therapies and preparing denial letters for approval by pharmacists.

Following the DER guidelines to make decisions on approvals and/or denials on drug products that are out of scope of the formulary plans.

Member Engagement Representative (Ops Member Engagement Unit

Collection and Verification of information concerning eligibility, provider status, benefit coverage, coordination of benefits and subrogation.

Provides customer service functions and coordinates member needs with the appropriate level of care.

Applies policies and procedures, regulatory requirements and accreditation standards to all activities.

Performs data entry of authorizations, contracts, in the EMMA system and schedules nursing assessments in Outlook.

Special projects including fulfillment of educational material, data entry, research, records retrieval, and Health Assessments.

Assists in preparing and submitting projects, reports or assignments as needed to meet organizational initiatives and/or objectives.

US Imaging Radiology Tampa, FL 2014 - 2014

Lead Medical Appointment Scheduler

Inbound and outbound calls for members; scheduling for appointments, contacting the member to advise them of any updates to their coverage.

Maintains strictest confidentiality; adheres to all HIPAA guidelines/regulations.

Scheduled members for radiology testing, and ultrasounds. Contacted members MDO's contacted insurance companies for updated information restarting member plans.

Applied billing, and insurance codes accurately at check out.

Proficient knowledge of CPT and ICD-9 coding.

2

JOSEPH HOLLAND

WellCare Inc. (Exactus Pharmacy Solutions) Tampa, FL 2013 - 2014 Pharmacy Support Clerk

Labeling of incoming faxes in the Right Fax program application to ensure critical DER turn-around timeframes are met and in compliance.

Logs and process medical claims received by the department. Performs assigned special projects

Research and Processes of Direct Member Reimbursements received by the Pharmacy Department.

Assistance with the processing of DERs using Paradigm and WHI program applications.

Organization of multiple administrative and clinical tasks and the prioritization of work project tasks in chronological order of importance to create a positive impact on members and providers. Terminix Pest Control Inc. Tampa, FL 2013 - 2013

Call Center Customer Care

Handles customer calls/correspondence for scheduling and inquiries.

Offers assistance to customers with service, billing or other issues.

Records all customer information and call history information accurately on appropriate paperwork or electronic systems.

Ensures maximum sensitivity, proper routing and responsiveness to all customer requirements.

Maintains level of knowledge and understanding of features of service, operating systems, marketing promos and special offers.

Beall's Outlet Tampa, FL 2012 - 2013

Retail Supervisor

Orients, trains, schedules, monitors, evaluates and provides direction to Store Staffing and Volunteers; complete timesheets and attendance records.

Handles cash and receipts for the sale of merchandise by performing duties such as counting the float, balancing cash, providing change, sorting and securing cash.

Promotes the store by performing duties such as placing advertisements in newspapers, on radio and television and attending trade shows.

Medco Health Solutions Tampa, FL 2004 - 2011

Customer Service Representative

Partnering with customer service professionals responsible for Medicare Part D prescription drug plans, assisting customers with answering questions and enrollment requests.

Supporting Open Enrollment periods, assisting employees with opening new accounts, providing details information about programs and plans.

Processing refills, advising members of drug coverage levels/limits, pricing, processing payments and triaging calls to redirect internally.

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