Alessandria (Ally) Hernandez
San Antonio,TX
Summary
Successful CPhT bringing 9 plus years of experience in filling prescriptions with expert accuracy, building relationships with customers and promoting teamwork within pharmacy settings. Experience with insurance claims including PA requirments and problem solving rejections. Knowledgeable about regulatory guidelines and policies governing fraud, waste and abuse.
Overview
12
12
years of professional experience
Work History
Sr PA/Appeals Rep CphT
Optum Specialty Pharmacy (Remote)
San Antonio, TX
01.2022 - Current
- Collaborated with health care providers, members, and other stakeholders to resolve issues in a timely manner.
- Assessed appeals and grievances to determine eligibility for reconsideration or review.
- Conducted research on complex cases to ensure accurate resolution of appeals and grievances.
- Developed procedures for tracking appeal requests and processing outcomes.
- Identified areas of improvement in the appeals process and developed strategies to enhance efficiency.
- Interpreted insurance policies and regulations related to appeal decisions.
- Monitored incoming correspondence from members, providers, employers, state agencies. to ensure timely response to inquiries.
- Provided education on the appeals process to staff members as needed.
- Reviewed medical records for accuracy prior to submitting an appeal decision.
- Updated departmental databases with information pertaining to each case reviewed.
CPhT/RPhT
Walmart Pharmacy #999
San Antonio, TX
07.2016 - 05.2022
- Promoted high customer satisfaction by resolving problems with knowledgeable and friendly service.
- Understood and followed oral and written directions.
- Worked successfully with diverse group of coworkers to accomplish goals and address issues related to our products and services.
- Demonstrated leadership by making improvements to work processes and helping to train others.
- Prioritized and organized tasks to efficiently accomplish service goals.
- Identified needs of customers promptly and efficiently.
- Planned and completed group projects, working smoothly with others.
- Assisted with customer requests and answered questions to improve satisfaction.
- Maintained updated knowledge through continuing education and advanced training.
- Approached customers and engaged in conversation through use of effective interpersonal and people skills.
- Displayed strong telephone etiquette, effectively handling difficult calls.
- Recognized by management for providing exceptional customer service.
- Achieved cost-savings by developing functional solutions to problems.
Wait Staff/ Bartender
Air Force Village I (Blue Skies of Texas East)
San Antonio, TX
09.2013 - 07.2016
- Greeted customers and provided excellent customer service.
- Prepared alcoholic and non-alcoholic beverages according to recipe standards.
- Ensured proper sanitation of bar area, glassware, utensils, and equipment.
- Maintained inventory of liquor, beer, wine, and other beverage items.
- Provided drink suggestions to customers based on their preferences.
- Processed payments accurately and efficiently with POS system.
- Assisted in setting up the bar for service shift.
- Kept track of all orders made by customers and communicated them promptly to kitchen staff.
- Stocked ice bins and coolers as needed throughout shift.
- Monitored guests' alcohol consumption levels to prevent over-intoxication or underage drinking.
- Resolved customer complaints in a professional manner.
- Attended regular training sessions to stay updated on new products or trends.
- Managed cash drawer at the end of each shift ensuring accuracy of funds received.
- Developed good working relationships with fellow employees through effective communication.
- Checked identification cards for proof of age prior to serving alcohol beverages.
- Managed bar area, cocktail design and menu and handled inventory, regulation compliance and customer relationships.
- Poured wine, beer and cocktails for patrons.
Research Interviewer
Scarborough (Nielsen) Research Center
San Antonio, TX
06.2014 - 09.2014
- Conducted in-depth interviews with participants to gather data and information on research topics.
- Developed interview protocols, questionnaires, and scripts for research projects.
- Facilitated focus groups to discuss research topics and gathered insights from participants.
- Ensured compliance with applicable regulations pertaining to privacy and confidentiality of respondents' personal information during all stages of the research process.
- Managed a large caseload of telephone interviews in a timely manner while meeting quality standards set by supervisors.
- Utilized effective listening skills when interacting with participants during interviews.
- Documented results from participant observations.
- Entered participant data into databases.
Cashier/Cook
Carl’s Jr. Food Restaurant #442
Von Ormy, TX
06.2012 - 10.2013
- Operated cash register efficiently and accurately, processed payments by cash, check, credit card, gift card or automatic debit.
- Counted money in cash drawer at the beginning of shift to ensure that amounts were correct and have sufficient change.
- Issued receipts, refunds, credits or change due to customers.
- Assisted customers over the phone regarding store operations, product information and order placement.
- Maintained cleanliness of checkout area including countertops, registers, windowsills and floors.
- Ensured compliance with all safety regulations within the store environment.
- Prepared meals according to recipes and menus, adjusted ingredients and cooking times accordingly.
- Adhered to food safety standards when storing and preparing foods.
- Cleaned kitchen equipment, surfaces, utensils and dishes.
- Ensured that all food was cooked at the correct temperature and stored correctly.
- Maintained a clean working environment by sweeping, mopping floors, washing surfaces and emptying trash cans.
Education
Associate of Applied Science - Pharmacy Technology
Northwest Vista College
San Antonio, TX05-2016
High School Diploma -
Southwest High School
San Antonio, TX06-2012
Skills
- Detail Oriented
- Organizational skills
- Task Prioritization
- Reliability
- Adaptability
- Microsoft Word, Excel, PowerPoint
- Microsoft Office proficiency
- Bilingual (English and Spanish)
- Computer experienced
- Insurance knowledge
- Dispute Resolution
- Teamwork and Collaboration
- Adaptability and Flexibility
- Analytical Thinking
Career Focus
I am a very dependable and caring person. I love working and interacting with people. When it comes to working, I’m always determining to get the job done. I don’t believe in giving up, and I also believe that success is a must. I love to learn, I’m encourage in learning new things. I’m bilingual (English and moderate Spanish).
Availability
Open Availability
Timeline
Sr PA/Appeals Rep CphT
Optum Specialty Pharmacy (Remote)
01.2022 - Current
CPhT/RPhT
Walmart Pharmacy #999
07.2016 - 05.2022
Research Interviewer
Scarborough (Nielsen) Research Center
06.2014 - 09.2014
Wait Staff/ Bartender
Air Force Village I (Blue Skies of Texas East)
09.2013 - 07.2016
Cashier/Cook
Carl’s Jr. Food Restaurant #442
06.2012 - 10.2013
Associate of Applied Science - Pharmacy Technology
Northwest Vista College
High School Diploma -
Southwest High School