Alexis Kauth
Oakley,CA
Summary
Experienced and dedicated Initial Review Specialist with a proven ability to effectively lead and motivate team seeking a Supervisor Initial Review Pharmacy Technician position to leverage my leadership skills and commitment to quality assurance to drive excellence and contribute to the overall success of the medical drug review department while prioritizing patient care.
Overview
12
12
years of professional experience
1
1
Certification
Work History
Initial Review Pharmacy Specialist
Prime Therapeutics (formerly Magellan Rx)
04.2022 - Current
- Promoted from Initial Review Pharmacy Technician to Lead Initial Review Pharmacy Technician (4/2022), then re-titled to Initial Review Pharmacy Specialist after company acquisition by Prime Therapeutics (12/2022).
- Provides coaching to other staff when help is needed in resolving claim submission errors.
- Assists other technicians with their daily reviews, questions and for interpretations of policies to ensure clinical criteria adheres to Medicare guidelines and policies.
- Regularly monitors claims within active work queues while communicating and delegating tasks as needed to ensure claims are reviewed within proper turn around time.
- Reviews new medications and guidelines with technicians.
- Coordinates regularly and effectively with supervisors and Clinical Pharmacists Review team to ensure proper adherence to Medicare requirements and clinical guidelines.
- Onboards new employees with training and new hire documentation.
- Develops and maintains training materials for new hires.
- Identifies system errors and acts as a point person to communicate with appropriate management for resolution.
- Regularly reviews and monitors information on pended claims for quality assurance.
- Ensures clinical criteria is accurately collected, notated and appropriate recommendations are made.
- Identifies training needs and reviews with supervisor.
- Strong understanding of the organizations policies and procedures.
- Provides provides productive feedback and recognition to drive overall team performance.
- Actively participates in process/project conversations to improve effectiveness of workflows to positively impact clients, agents, leadership and patient care (i.e: developed Medical Drug Review Information OneNote).
- Consistently maintains flexible reliability and availability to ensure team and business needs are appropriately supported.
- Assists supervisor in completing special projects as necessary.
Initial Review Pharmacy Technician
Magellan Rx
12.2020 - 04.2022
- Reviews and documents patient information and checks appropriateness using clinical criteria guidelines, specializing in Medicare guidelines.
- Familiar with commercial policy guidelines and processes.
- Makes approval recommendations that meet clinical review criteria.
- Assists with the documentation and implementation of written and verbal communications to physicians/prescribers.
- Communicates regularly and effectively with managers and pharmacists to ensure proper adherence to Medicare requirements and clinical guidelines.
- Familiar with clinical resources such as NCCN, Micromedex and Clinical Pharmacology.
- Familiar with Medicare Coverage Database and specific turn around time guidelines.
- Conducts audits including outreach and review of medical records to audit authenticity of provider response during Prior Authorization reviews.
- Practices and maintains specific company policies and procedures.
Senior Certified Pharmacy Technician
Walgreens
07.2013 - 11.2020
- Coordinated verification and filling of more than 500 daily prescriptions in high-volume 340B retail pharmacy environment with a 99% verified by promised time.
- Responsible for compassionate customer service and accurate payment processing in a fast-paced pharmacy.
- Supervised 5 pharmacy technicians including scheduling shifts and coordinating day-to-day assignments.
- Maintained proper drug storage procedures, registries, and pharmacy records.
- Managed inventory. Decreased excess inventory by 25% within 1 year.
- Was the "go-to" to resolve non-routine issues like third-party billing, computer system and customer service issues.
- Consistently exceeded goal expectations and position advancement timeframes.
- Consulted with insurance company representatives to complete claims processing, resolve concerns and reconcile payments.
- Set up and modified patient profiles in Intercom+ to include current information such as medications and insurance details.
- Restocked automated medication dispensing equipment (Yuyama).
- Strong relationship builder, able to quickly establish rapport with team members and customers.
- Supported in setting up and running off-site flu-clinics in local churches and senior centers.
Education
Associate of Science - Pharmacy Technology
Carrington College California
Antioch, CA06.2013
Skills
- Typing speed of 105 WPM
- Expert understanding of Medicare/Medicaid/340B
- Strong verbal and written communication
- Employee Training
- Confidentiality and HIPAA
- Medical terminology
- Problem solving
- Advanced math skills
- Fast, accurate prescription filling
- Knowledge of brand and generic drugs
- Pharmacy records management
- Inventory management
- Maintaining pharmacy equipment
- Receiving incoming shipments and supplies
- Very familiar with supply and stock ordering process
Certification
- Certified Pharmacy Technician (CPhT)
Timeline
Initial Review Pharmacy Specialist
Prime Therapeutics (formerly Magellan Rx)
04.2022 - Current
Initial Review Pharmacy Technician
Magellan Rx
12.2020 - 04.2022
Senior Certified Pharmacy Technician
Walgreens
07.2013 - 11.2020
Associate of Science - Pharmacy Technology
Carrington College California
Similar Profiles
MARK ALLENMARK ALLEN
Senior Data & Reporting Analyst at Magellan Health RX, A Prime Therapeutics CompanySenior Data & Reporting Analyst at Magellan Health RX, A Prime Therapeutics Company
Claudia LobergClaudia Loberg
Account Manager at Partners Rx/Magellan Rx Management/PrimeAccount Manager at Partners Rx/Magellan Rx Management/Prime
Matiya CromartieMatiya Cromartie
Clinical Pharmacy Technician II at Magellan Health/Prime TherapeuticsClinical Pharmacy Technician II at Magellan Health/Prime Therapeutics
Joshua BallesterosJoshua Ballesteros
Operations Manager – Energy Sciences Area at Lawrence Berkeley National LaboratoryOperations Manager – Energy Sciences Area at Lawrence Berkeley National Laboratory
Amanda HurdAmanda Hurd
AR Representative at Golden State Orthopedics and SpineAR Representative at Golden State Orthopedics and Spine