Alma Aquino
Paramount,CA
Summary
Accomplished Senior Prior Authorization Specialist at Optum Rx with a track record in claims processing and collaboration across departments. Skilled in educating healthcare providers on prior authorization needs while providing exceptional customer service. Strong focus on documentation accuracy and relationship management to support patient care initiatives. Effective remote worker known for high productivity and expertise in customer service, time management, and technical troubleshooting.
Overview
19
19
years of professional experience
Work History
Sr Prior Authorization Specialist
Optum Rx
Cypress, CA
07.2023 - Current
- Process electronic prior authorizations requests from CoverMyMeds
- Processed fax prior authorization requests
- Process GLP-1 authorizations and evaluate if chart notes meet criteria
- Understanding of Clinical Guidelines and evaluate for approval or denials
- Part of pilot group that developed GLP-1 processing/authorizations
- Reviewed claims submitted without valid pre-authorization codes and took corrective action when necessary.
- Collaborated with internal staff members to resolve discrepancies or issues related to prior authorizations.
- Advised provider offices on proper coding practices that are necessary for successful claim submission.
- Educated healthcare professionals on how to properly submit a request for pre-authorization.
- Researched clinical criteria and determined eligibility for requested services based on plan provisions.
- Coordinated with other departments to obtain additional information needed for prior authorization.
- Reviewed prior authorization requests to ensure accuracy and completeness of required information.
- Educated healthcare providers on prior authorization requirements and insurance formulary changes.
- Input claim, prior authorization, and other important medical data into system.
- Coordinated with healthcare providers to gather necessary patient information for prior authorization requests.
- Communicated authorization decisions, including approvals and denials, to healthcare providers and patients.
- Coordinated with pharmacy staff to ensure medications requiring prior authorization are processed correctly.
- Participated in multidisciplinary team meetings to discuss complex cases requiring prior authorization.
- Determined which party would be liable for payment on medical services by thoroughly reviewing patient insurance coverage.
- Conversed with people from different cultures daily, providing high level of respect and patience with each interaction.
- Proofread documents carefully to check accuracy and completeness of all paperwork.
- Maintained positive working relationship with fellow staff and management.
Pharmacy Technician
Rite Aid Pharmacy
Downey, CA
02.2011 - 07.2023
- Teamed with peers, technicians and pharmacists to prioritize and complete orders.
- Created new customer profiles and updated demographics, allergies and new medications in pharmacy computer systems.
- Assisted pharmacist with clearing high volume of prescriptions and responded to customer questions.
- Interpreted and processed medication orders under supervision of pharmacist.
- Inspected medication storage locations to monitor drug expiration dates and supply adequate inventory.
- Received and verified daily incoming drug inventories, reported discrepancies and logged items into inventory system.
- Refilled medications, offered insight into over-the-counter products and verified insurance benefits.
- Prepared prescription transfers to other pharmacies.
- Liaised with pharmacist to measure and prepare medication doses and packaging and label prescriptions.
- Maintained pharmacological practices by checking drug inventory, stocking medications and monitoring supplies.
- Flagged potential side effects and allergies to prescribed medications for patients.
- Verified prescriptions and drug labels, documents and packages.
- Maintained strict patient confidentiality to adhere to HIPAA regulations and avoid data compromises.
- Maintained clean and organized pharmacy shelving and work areas.
- Verified patients' identities at pickup to prevent sale of wrong medications.
- Managed inventories, rotated stock, removed expired or damaged drug products and resolved discrepancies in drug counts.
- Performed wide range of pharmacy operations with strong commitment to accuracy, efficiency and service quality.
- Efficiently processed cash register transactions for new and refilled prescription orders.
- Completed and filed patient paperwork, updating records in system with insurance carrier changes and allergy information.
- Prepared prescription labels, promoting accuracy in medication administration and dosing.
- Adhered to regulatory guidelines for workplace safety and customer confidentiality.
- Worked with insurance companies to process claims, resolve problems and obtain payments.
- Established and updated patient profiles, medications and insurance details.
- Consulted with customers via telephone or in-person to assist with navigating pharmacy systems and completing requests.
- Adhered to infection control policies and procedures to prevent spread of disease.
- Compiled customer demographic, allergy and medical history background.
- Closely inspected medications to determine accuracy of identities, strengths and purities.
- Processed prescription transfer requests from competitors.
- Requested scripts from doctors and verified insurance and coding.
- Established clear and effective customer service policies to increase satisfaction and pharmacy loyalty.
- Participated in prescription pharmaceutical and over-the-counter product inventory audits.
- Worked successfully with diverse group of coworkers to accomplish goals and address issues related to our products and services.
- Assisted pharmacists in local flu clinics and immunizations
Front End Clerk/Pharmacy Cashier
Rite Aid
Huntington Park, CA
01.2006 - 02.2011
- Handled customer problems with knowledgeable, speedy and friendly service.
- Received and processed payments, handed out change and provided receipts.
- Promoted store cards and special programs and helped customers complete paperwork.
- Organized store by returning merchandise to proper areas and restocked displays.
- Answered customer questions and referred to pharmacist for medication information.
- Participated in prescription pharmaceutical and over-the-counter product inventory audits.
Education
High School Diploma -
Lynwood High School
Lynwood, CA06-2005
Skills
- Preparing Bulk Medications
- Verifying Orders
- Proper Labeling Procedures
- Medication Storage and Labeling
- Cash Register Operations
- Medication Documentation
- Prescription Filling and Labeling
- Payment Processing
- Prescription Order Verification
- Recordkeeping and Documentation
- Prescription Refill Fulfillment
- Dispensing Medications
- Patient Profile Setup
- Familiar with Outcomes MTM platform
- Storage Maintenance and Security
- Relationship Building
- Prioritization and Organization
- Verbal and Written Communication
- Data Entry
- Customer Service
- Answering and Routing Calls
- Supporting Pharmacy Operations
- Insurance Verification
- Quality Assurance and Control
- FDA Compliance
- Workflow Optimization
- Labeling Prescriptions
- Resolving Customer Issues
- Insurance Billing
- Claims processing
- Attention to detail
- Cultural sensitivity
- Claim research
- Adaptability and flexibility
- Cross-department collaboration
- Documentation accuracy
- Issue research
- Retro-authorizations
- Prior authorizations
- Resource information
- Multitasking capacity
- Continuous learning attitude
Accomplishments
- Currently preparing to train new hires
- Employee of the month
- Exceeded goals and performance
Languages
English
Native/ Bilingual
Spanish
Native/ Bilingual
References
References available upon request.
Timeline
Sr Prior Authorization Specialist
Optum Rx
07.2023 - Current
Pharmacy Technician
Rite Aid Pharmacy
02.2011 - 07.2023
Front End Clerk/Pharmacy Cashier
Rite Aid
01.2006 - 02.2011
High School Diploma -
Lynwood High School
Similar Profiles
Tamika BucknerTamika Buckner
Patient Care Coordinator at Optum RXPatient Care Coordinator at Optum RX
Ashlee AndersonAshlee Anderson
Pharmacy Technician at Optum RXPharmacy Technician at Optum RX
Kurt AdkinsKurt Adkins
Pharmacy Manager at Optum RxPharmacy Manager at Optum Rx
Dani PonceDani Ponce
Client Services Specialist at AXSClient Services Specialist at AXS
Claudia LomeliClaudia Lomeli
Litigation Paralegal at Panish Shea Ravipudi, LLCLitigation Paralegal at Panish Shea Ravipudi, LLC