BRIEANNE ANDRADE
FOLSOM,CA
Summary
Highly skilled Pharmacy Technician with a strong background in insurance verifications and medical terminology. Proven track record of accurately analyzing insurance benefits and interpreting health plan policies to make informed decisions. Exceptional customer service skills, resolving inquiries and issues effectively. Experienced in working with HIPAA guidelines and regulations for Medicare, Medicaid and Commercial.
Overview
15
15
years of professional experience
1
1
Certification
Work History
Pharmacy Prior Authorization Representative
Cigna-Ever North Services Inc
03.2023 - Current
- Reviewed clinical documents such as progress notes, labs, radiology reports to verify accuracy and completeness of documentation before processing request for authorization.
- Analyzed insurance benefits, coverage limitations, network restrictions and other factors related to prior authorization requests.
- Provided exceptional customer service to both internal and external customers in order to resolve inquiries and issues effectively.
- Interpreted health plan policies and regulations pertaining to prior authorizations in order to make accurate decisions on each case presented.
- Experience in Medicare, Medicaid and Commercial health plans.
Lead Pharmacy Technician
Centene/Health Net Inc
11.2013 - 01.2018
- Processed a minimum of 80 prior authorization request into Paos from doctors and pharmacies
- Experience in many systems including Caremark, Paos, ABS, Qcare and Silverlink
- Experience with excel to complete staff schedules
- Experience working in a remote setting
- Coached,mentored and provided performance feedback to pharmacy technicians.
- Trained newly hired pharmacy technicians on department policies and procedures.
- Monitored pharmacy technician team's metrics to meet established benchmarks.
Order Entry/Customer Service Technician
Omnicare Pharmacy
06.2010 - 11.2013
- Experience in working with Assisted Living Facilities and Skilled Nursing Facilities
- Knowledge and experience in HIPAA guidelines and regulations
- Processed multiple orders for patients and various facilities.
- Experienced in call center atmosphere
- Filled patients medication using bubble packs and vials
- Worked with Omni Dx, Image Now programs and Cisco phone systems.
- Maintained detailed records of customer interactions, documenting all actions taken throughout the process.
- Developed relationships with customers by providing accurate information and helpful advice.
- Performed administrative duties such as updating account information, processing orders, and entering data into the database systems.
- Demonstrated exceptional customer service skills to clients in fast-paced call center environment, resolving inquiries and complaints in a timely manner.
Education
Bachelor of Psychology -
Southern New Hampshire University
Manchester, NH10-2026
Pharmacy Technician License -
Central Coast College
Salinas, California01.2008
High School Diploma -
King City High School
King City, California01.2005
Skills
- HIPPA compliance
- Patient insurance authorizations
- Multitasking
- Reliability
- Medical terminology
- Insurance procedures
- Attention to detail
- Effective communication
- Customer service
- Medicare, Medicaid and Commericial
References
References upon request
Certification
- TCH 81665
Timeline
Pharmacy Prior Authorization Representative
Cigna-Ever North Services Inc
03.2023 - Current
Lead Pharmacy Technician
Centene/Health Net Inc
11.2013 - 01.2018
Order Entry/Customer Service Technician
Omnicare Pharmacy
06.2010 - 11.2013
Pharmacy Technician License -
Central Coast College
High School Diploma -
King City High School
- TCH 81665
Bachelor of Psychology -
Southern New Hampshire University
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