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Work Background
Molina HealthcareCertified Pharmacy Technician
Jan. 2023RemotePerform initial receipt and review of non-formulary or prior authorization requests against plan approved criteria. Requests additional information from providers as needed to properly evaluate the request. Accurately enter online approvals or denials of requests. Authorized to make and carry out simple prior authorization requests within established policies and procedures. Participate in the development /administration of programs designed to enhance the utilization of targeted drugs and the identification of cost saving pharmacy practices. Identify and report departmental operational issues and resource needs to appropriate management. Assist Molina Member Services, pharmacies, and health plan providers in resolving member prescription claim, prior authorization, or pharmacy services access issues. Articulate Pharmacy Management policies and procedures to pharmacy/health plan providers, other Molina staff and others as needed. Received 2024 3rd quarter Spotlight award for willingness to work OT when needed.
Alignment HealthcareCertified Pharmacy Technician
Nov. 2018 - Dec. 2022Orange, CaliforniaConduct high volume of outbound calls to members, prescribers, and pharmacies in regard to the Adherence program; Assist members in refilling their medications, and reach out to the prescriber’s office if a member requires additional refills on their maintenance medications; Conduct outbound calls to pharmacies and prescribers to resolve prescription issues such as medication requiring Prior Authorization, assist retail / mail order pharmacies in resolving third party rejections, and reviewing daily rejections while ensuring CMS compliance; Interact with internal plan departments to address pharmacy related issues; Work closely with compliance department to make sure Pharmacy Programs meet the criteria established by CMS; Ensure all HMO members information is kept confidential according to HIPAA; Other duties as assigned.
OSO Home Care, Inc.Reimbursement Specialist (Billing) / Pharmacy Tech
Jul. 2017 - Nov. 2018Irvine, CaliforniaMaintain accurate daily billing and collection call logs; Audit claims for accurate billing procedures according to payer contracts; Effectively identify predictable claim problems and provide updates to supervisor; Maintain accurate notes and timely write-offs and consistently follows established protocols for the administration of patients account write-offs; Keep updates on client contracts, profiles and patient accounts; Communicate accurate info to team when changes occur; Post collections for claims accurately and ensure they are properly reconciled against client accounts; Conduct job duties in accordance with established guidelines and acceptable standards of industry; Actively participate in company’s CPI program
CalOptimaCertified Pharmacy Technician
Dec. 2014 - Feb. 2017Orange, CAClinical reviews of requested pharmaceutical products and services for prior authorizations; Assisted pharmacies, members, member advocates, doctors, internal departments, and health networks with completion of adjudications; Authorized to initiate and complete, on behalf of the pharmacy department, within established policies and procedures, pharmaceutical products and services decisions; Required Rotation of On Call After Hour pharmacy assistance for members directly. Reimbursement and Appeal processing. Versatile in all lines of business services of health care insurance available.
McGuff Company, Inc.Certified Pharmacy Technician
Jul. 2011 - Aug. 2014Santa Ana, CAResolved customer issues ensuring accurate information provided; Entered prescriptions and verifying appropriate information required; Assisted multiple departments with productivity, schedule adherence, and quality standards. Cross trained in dispensing room and regularly provided back up support with filling and labeling orders shipped in a timely daily manner throughout the work days as needed.
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