Patient Access & Pharmacy Authorization Specialist
Resume:
Armon Hardwick
Phoenix, AZ ***** • 602-***-**** • **********@*****.***
Work history
Patient Access Specialist, 05/2025 to Current
CND Life Sciences – Scottsdale, AZ
Assist provider offices with patient intake, insurance verification, and coordination for specialized neurological testing.
•
Provide medical offices with thorough insurance breakdown of coverage, verify benefits, and handle prior authorizations for specialized neurodiagnostic tests like the Syn-One test helping individuals dealing with neurodegenerative conditions such as Parkinson's disease and dementia.
•
• Checks health insurance coverage and handles billing questions from providers and patients.
• Analyse patient health coverage accumulators to provide billing breakdown for neurological test.
• Communicate with colleagues and provider offices regarding changes and updates.
• Initiate prior authorization when prompted by health plans. Communicate with providers office via email when requesting additional information to complete neurological test request.
•
• Triage faxes and email from provider offices and patient. Member Advocate, 01/2024 to 05/2025
Maxor National Pharmacy Services, LLC – Amarillo, TX Assist in developing, preparing, and managing formularies, preferred drug lists, prior authorization criteria, and step therapy protocols in compliance with CMS Medicare Part D guidelines.
•
Assist in developing, preparing, and managing formularies, preferred drug lists, prior authorization criteria, and step therapy protocols in compliance with CMS Medicare Part D guidelines.
•
Support clinical and/or formulary compliance efforts for government programs such as Medicare Part D and Medicaid.
•
• Assist in formulary change analysis and disruption evaluation for the organization. Communicate formulary changes, recommendations, quantity limitations, and clinical initiatives internally (e.g., to systems, operations, account managers, customer service) and as directed.
•
• Support CMS formulary administration audits.
• Communicate with specialty pharmacies and provide update to specialty formularies. Patient Advocate Representative, 04/2021 to 11/2024 Advanced Medical Pricing Solutions – Phoenix, AZ
• Maintain HIPAA guidelines.
• Run and disburse daily welcome letters to introduce the patient AMPS advocacy team.
• Conduct daily welcome calls to members and patients.
• Review and verify Balance Bills using provider billing statements and theExplanation of Benefits.
• Prepare and file correspondence regarding challenges to the Plan's reimbursement.
• Assist and support members with questions regarding the FCBA dispute process.
• Upload incoming emails, faxes, and mail into the system for proper handling.
• Respond to incoming correspondence received via email, fax, mail and phone within24-48 hours. Maintain contact with facilities, professionals, EBO's and debt collectors to assistwith the resolution of open advocacy matters.
•
• Provide exceptional customer service for incoming calls throughout the shift.
• Accurate and complete documentation of all daily interactions.
• Complete a minimum of 40-50 interactions per shift.
• Work independently and effectively collaborates with the team. Act as liaison with TPA partners, employer groups, and brokers as needed to assistand resolve open advocacy matters.
•
• Propose process improvements to enhance member satisfaction.
• Escalate advocacy or other complaints per written guidelines.
• Update all members / patients with an open advocacy matter every 30 – 45 days. Member Service Representative, 05/2016 to 08/2020
Aetna, a CVS Health Company – Phoenix, AZ
• Verify member benefit information.
• Verify AHCCCS eligibility status.
• Initiate behavioural health consultations.
• Verify co-insurance and primary insurance eligibility status.
• Request peer-to-peer reviews for appeals.
• Reserve medical transportation.
• Knowledge of SMI/BH proceedings
Customer Care Specialist, 01/2013 to 09/2016
Avesis, Incorporated – Phoenix, AZ
• Assist member and providers with general information.
• Verify eligibility, benefits, procedures, and HIPAA with providers.
• Record and route escalated C.A.G. calls that are not resolve with 1st call resolution.
• Obtain knowledge of procedures and protocols for verity of healthcare organizations.
• Logging and tracking calls that are completed and follow up with members/providers Customer Service Representative, 08/2011 to 03/2013 LogistiCare – Phoenix, AZ
Responsible for assisting Medicare and Medicaid Members with questions and solution about their current plans.
•
• Schedule medical reservations for members.
• Train new hires on System Navigations.
Assist the supervisor and other management on Escalated calls and answer questions that peers may have with daily functions.
•
• Dispatch of medical transportation vehicles.
Security Guard, 02/2008 to 09/2011
ProGuard Security Services – Phoenix, AZ
• Security patrol for industrial and commercial locations.
• Respond to alarms and investigation of disturbances.
• Monitor and authorize the arrival and departure of all employees, visitors and other personnel.
• Maintained a safe working facility.
• Logged daily reports of activities and irregularities. Cashier, 08/2005 to 12/2008
HMSHost by Avolta – Phoenix, AZ
Utilizing customer service skills as part of daily functions when greeting customers and potential clients.
•
Managed a crew of five employees: daily assignments, transactions, scheduling, meetings and any additional training to maintain a functional and productive work space.
•
• Inventory checks.
• Daily
Skills
• Medical Terminology
• Computer Technology
• Home Office
• Billing
• Medical Administration Support
• Customer Service
• Patient Care
• HIPAA
• Pricing
• Microsoft Windows
• Insurance Verification
• Medicare
• Medicaid
• As400AS400
• 35+ WPM
Education
Information Technology, 05/2017
Phoenix College - Phoenix, AZ
General, 05/2004
North High School - Phoenix, AZ
Professional summary
Professional in patient access with strong focus on team collaboration and achieving results. Skilled in patient registration, insurance verification, and handling sensitive information with confidentiality. Known for flexibility in adapting to changing needs and relying on strong communication and problem-solving abilities. Prepared to make significant impact in ensuring seamless patient access and satisfaction.
Contact this candidate