Summary
Licensed pharmacy technician for the California State Board of pharmacy since February 2011 with over 4 years experience in pharmacy settings ranging from office, inpatient, outpatient, retail and recently mail-order. Respected leader with ability to train and manage diverse teams as a lead technician to deliver peak performance. Dedicated to providing quality patient care along with fast-paced and accurate medication dispensing. Referenced from any employer as an honourable data entry clerk, customer service representative, medical billing representative and prior authorization clerk. Outstanding interpersonal skills with a track record of establishing positive relationships with customers, pharmaceutical representatives/manufacturers, coworkers, medical professionals, healthcare organizations and insurance providers. High-level experience in medical billing of HMO and PPO health plans with extensive knowledge in Medicare—including Parts A-D. Diligently skilled and ambitious in all aspects of pharmacy operations and the proper preparation of medications. Gathered fabulous knowledge of medication and pharmaceuticals. Strong computer and communication skills. Extraordinary skills in Microsoft Word, Excel, Outlook, Access, Publisher, PowerPoint and OneNote. Typing speed of 60 WPM with 99-100% accuracy. ***NOTE: VERY DETAIL ORIENTED***
Work History/Experience
LifeCare Solutions – (December 2015-Present)
Reimbursement Specialist:
Prepare and handle billing for accounts to ensure timely reimbursement
Identify insurance requirements including DMERC and Medicaid qualifications needed to ensure payor requirements are met
Verify balances and receipts of all cash payments
Research overdue accounts and follow up by mail and/or phone to insurance carriers or customers on delinquent payments
Review claims denied for payment or underpaid claims
Resubmit claims with proper documentation for further carrier review
May coordinate collection activities for delinquent accounts by preparing information for collection agencies
Post payments and service dates to accounts to ensure accurate payment status and accurate account activity
Research unidentified payments using internal sources, written communication or phone inquiries to determine appropriate accounts to post payments
Prepare and post adjustments to appropriate accounts as necessary
Prepare necessary documentation to process refunds if overpayments have occurred
Respond to customer inquiries regarding account status in a timely manner
Research customer accounts thoroughly and documents appropriately
Resolve discrepancies and prepare adjustments and refunds as necessary
Audit incoming paperwork for completeness and accuracy to ensure proper documentation for billing purposes
Recorded batches received and documented errors
Brings recurring issues to the attention of management
Maintain accurate and current data files on all accounts

Millennium Health Laboratories – (September 2015-November 2015)
Medical Biller I:
Data entry and Error Processing of over 370 accessions and claims daily pertaining to a vast array of insurances nationwide including but not limited to Medicare, Medicaid, TPA, Worker’s Compensation, Capitations, Aetna, Cigna, Paramount, United Healthcare, Molina, CHAMPVA, Superior, Amerigroup, Tricare for Life, Humana, Health Net and many other commercial insurances. Currently 14 projects already completed within 2 months.
Verifying eligibility through Passport One Source, NaviNet and Availity for over 500 insurances within the categories of Commercial, Government, Government HMO/MCO, TPA, Worker’s Compensation, Military and Liability insurance
Applied coding principals and guidelines, both internal and external in the assignment of diagnoses and procedure codes by interpreting medical information, diagnostic descriptions and procedures in order to accurately assign and sequence the correct ICD-10-CM and CPT codes
ICD-9 and ICD-10 converting with precision and accuracy on medical claims. Strong knowledge of medical terminology, policies and procedures to withhold outstanding compliance within the workplace
Identifies and resolves issues regarding account adjustments, low payment and collections.
Covance Specialty Pharmacy – (May 2015 – September 2015)
Program Specialist II:
Case management for Support Path patients in regards to obtaining financial assistance with various terminal illness medications
Verifying insurance eligibility through Emdeon
Evaluation of claim denials for appeals
Maintaining patient profiles with the most current and accurate data in real time
Responds to billing inquiries from patients, insurance companies and departments.
Program Representative: Data entry of all inbound and outbound documents with daily average of 300 documents per day with 99.8% accuracy
Provided technical guidance to physicians and other departmental staff in identifying and resolving issues or errors.
OptumRx—Mission Valley, CA (May 2013-December 2014)

Pharmacy Technician:
Processed all pertinent prescription/patient data at a rate of 32 prescriptions per hour with and accuracy of 99.4%
Assisted pharmacists with updating patient data, prescription processing, medical billing, problem resolutions, processing claims and eliminating quality assurance errors
Applied coding principals and guidelines, both internal and external in the assignment of diagnoses and procedure codes by interpreting medical information, diagnostic descriptions and procedures in order to accurately assign and sequence the correct ICD-9 and CPT codes.
delivered strong and compassionate communications with patients, medical professionals and insurance providers in regards to medical billing of Medicare Parts B and D and various 3rd party providers; applied payments to patient prescription orders and aided in the resolution of medical billing claims in collections while demonstrating outstanding customer service
Performed reconciliation of incomplete documentation issues, activities, appointments, completion and coding of billing documents, and CDM/Fee Schedule maintenance and changes.
MedImpact Healthcare Systems, Inc – (May 2012-April 2013)

Data Entry Clerk:
Processed codes for billing purposes in regards to patient insurances for prior authorizations from healthcare providers; maintained updates to patient profiles
Coordinated billing functions for services in accordance with various employer contract policies/procedures and workers’ compensation payors following internal office policies and procedures.

Prior Authorization Technician/Customer Service Representative—
Fulfilled more that 1,500 authorizations weekly with high precision and accuracy. Consulted verbally with ambition and phone communication to physicians, patients, coworkers, hospitals and various healthcare/insurance providers to obtain resolutions to insurance claims, prescription dosages, drug interactions, medical equipment, disease management, side effects and OTC medications. Data entry of prior authorization faxes/prescriptions, patient records, dosing information and medical billing. Maintained verbal interaction with HMOs and a wide range of insurance providers concerning billing and reimbursement issues. Kept abreast of new developments within the pharmaceutical industry.
Prepared executive summary reports, process/charge analysis and provide input and suggestions for implementing policies and procedures to ensure correct and timely billing for all services provided
Education
High School Diploma—Person High School, Roxboro, NC (June 2007)
Pharmacy Technician License—Newbridge College/CA State Board of Pharmacy, El Cajon, CA (February 2011) License Number: TCH-110481
References
Available Upon Request
Salary Requirements (Year of 2016)
$19-$24 per hour