Bobbie Dean
Actalent / MedImpact
GREENWOOD,IN
1
Certification
12
Years of experience
I am a Certified Pharmacy Technician and Prior Authorization Coordinator with 11 years experience in PBM operations. I have worked in many roles including PA & Appeals Coordinator, Intake / Date Entry Specialist, Patient Billing and Collections Representative, and SME (subject matter expert) for newly hired team members. I am strong in attention to detail and claims accuracy and have a genuine commitment to positive member health outcomes. I am comfortable working independently in a remote environment while maintaining effective communication, confidentiality, and productivity.
Work History
Prior Authorization Coordinator
1 Year 2 Months- Follow Intake process for faxed PA requests verifying member, prescriber, medication, priority, and letter of response or initial request
- Review chart notes to answer clinical guidelines questions
- Determine if drug criteria is met and approve or deny claim
- Outreach on EPA's and verbal requests not containing sufficient information
- Calculate over-dollar claim amounts and make dollar adjustments
- Perform all over-rides for approved medication prior authorizations
- Resolve pharmacy inquiries and claim rejections re-adjudicating claim for payment
- Utilize Micromedex for drug utilization review
- Ensure all proactive prior authorizations are entered for drug approvals with multiple strengths
- Knowledge of state sponsored pharmacy plan's policies
- Verify preferred drug by cross-referencing PDL (preferred drug list), brand vs generic, and step therapy drug lists
Prior Auth Specialist /Appeals Coordinator
7 Years 2 Months- Appeals Coordinator - review letter of appeals, input addition clinical information received into appeals claim, answer appeals inquiries from provider's office and provide status, participate in appeals dept meetings, send out determination letter and document system.
- PA Specialist - answer inbound calls from pharmacy, member and provider's office providing superior customer service.
- Stayed current with job aids, updates, laws, and processes changes.
- Met accuracy, call handle time, and case volume expectations.
- Participated in regular meetings via Microsoft Teams
Certified Pharmacy Technician
4 Years 11 Months- Read, interpreted and entered prescriptions maintaining quality and production standards.
- Contacted prescriber's office to clarify drug, strength, quantity, and/or prescriber's information.
- Consulted with pharmacist for prescription substitutions due to out of stock drugs, duplicate therapy, or formulary changes.
- Faxed prescriber's office for renewals and refills.
- Made outbound calls to patients for payment of outstanding copay balances.
- Answered inbound calls regarding patient pharmacy benefits and billing inquiries.
Medical Billing Specialist
5 Years 4 Months- Processed medical claims accurately, ensuring timely submissions and compliance with regulatory standards.
- Reviewed patient billing information to resolve discrepancies and improve accuracy of accounts receivable.
- Implemented efficient billing procedures, reducing processing time and enhancing workflow efficiency.
- Billed Medicare and commercial payers for hospice services rendered using electronic billing through Emdeon, UGS, NGS, DDE, MISYS, and NextGEN.
- Verified patient insurance eligibility and demographic information.
- Posted reimbursements received with contractual adjustments.
- Knowledge of each payer's billing and coding requirements to ensure timely payments.
- Reviewed denied claims resubmitting and appealing when necessary.
Disability Claims Specialist
2 Years 7 Months- Evaluated disability claims for accuracy and compliance with federal and state regulations.
- Advised clients on claim status, eligibility criteria, and required next steps
- Requested and read claimant's medical records to determine eligibility for disability, benefit amount and type of disability appropriate (STD, LTD, FMLA).
- Followed claimant's disability claim, received paperwork and interviewed claimant when necessary to make a final determination.
Education
Associate of Arts - Health Information Management
Skills
Prior authorization intake and claims processing
Clinical guidelines review
Claims rejection resolution
Override processing
Prescriber and pharmacy outreach
Claims approval / denial determination
Drug utilization review
Chart-notes research & review
Microsoft Excel and internal spreadsheets
ICD-10 coding
Medical terminology
Reliability
collaboration and teamwork
Certification
- CPhT - Certified Pharmacy Technician - 11 yrs
Timeline
Prior Authorization Coordinator
Actalent / MedImpact
05.2025 - 07.2026Read More
Prior Auth Specialist /Appeals Coordinator
C-Spring / OptumRX
03.2018 - 05.2025Read More
Certified Pharmacy Technician
Express Scripts Pharmacy
11.2012 - 10.2017Read More
Medical Billing Specialist
Hospice Family Care
12.2006 - 04.2012Read More
Disability Claims Specialist
VPA - Sedgwick
03.2004 - 10.2006Read More
Maricopa Community Colleges, Phoenix College
Associate of Arts from Health Information Management
Read More