Carlene Emile Rogers
TAMARAC
Summary
I'm a flexible person who excels in a fast-paced environment looking for a position with growth opportunities. Self-motivated and driven to exceed customer satisfaction goals and build long term relationships with not only with customers, but with fellow employees. Extremely skilled in interfacing and managing communication between different departments and key members. Hands on experience in interfacing with external sensitive information.
Overview
9
9
years of professional experience
1
1
Certification
Work History
Prior Authorization Representative
Cigna
07.2023 - Current
- Fielded telephone inquiries on authorization details from plan members and medical staff.
- Triaged unscheduled and emergency authorizations, directing submissions to appropriate personnel for rapid response.
- Contacted insurance companies to obtain prior authorization for medical procedures and medications.
- Prepared and distributed denial letters, detailing reasons for denial and possible appeal measures.
- Analyzed medical records and other documents to determine approval of requests for authorizations.
- Provide patients and healthcare providers with drug coverage and initiate prior authorizations if required.
Registered Pharmacy Technician
Geniusrx
03.2019 - 03.2023
- Entered and processed patients' prescriptions into internal system.
- Helped pharmacist clear problematic prescriptions and address customer questions to keep pharmacy efficient.
- Performed various pharmacy operational activities with strong commitment to accuracy, efficiency and service quality.
- Assisted pharmacist by filling prescriptions for customers and responding to patient questions regarding prescription and medication-specific issues.
- Processed high-cost medications such as self-administering and diabetic medications. Oral and injectables.
- Answered incoming phone calls and addressed questions from customers and healthcare providers.
- Performed various pharmacy operational activities with strong commitment to accuracy, efficiency, and service quality.
Pharmacy Helpdesk
Envision RxOptions
04.2016 - 09.2018
- Provide assistance with rejection and provide overrides for pharmacy claims.
- Assistant members with inquiry on co-pays for drugs and drug formulary based on plan structure.
- Assist in initiating medication prior- authorizations for doctor offices and pharmacies.
- Ran test claims to see what medication will be covered by member plan from brand medications to tier1 generic medications.
- Worked diligently with patients and benefit coordinators on drug coverages.
- Requested updated prescriptions and medical information from physicians
Humana Member Services
Convey Health Solutions
03.2015 - 02.2016
- Assist members with benefit questions and and guidance of plan eligibility
- Resolved all customer complaints in professional manner while prioritizing customer satisfaction.
- Processed premium payments and set up automatic bill pay using members banking or credit card information
- Answered customer telephone calls promptly and in appropriate manner.
- Updated demographic changes for members upon request and changed primary care doctors for individual and group policies.
Education
High School Diploma -
Sheridan Technical College
Hollywood, FL01.2014
Skills
- Customer service focus
- Quick learner
- On time and reliable
- Honest, trustworthy and punctual
- Prescription Order Verification
- Dosage Calculation
- Health Insurance Plan Knowledge
- Reviewing Patient Information
Certification
- Registered Pharmacy Technician - 3 years
Timeline
Prior Authorization Representative
Cigna
07.2023 - Current
Registered Pharmacy Technician
Geniusrx
03.2019 - 03.2023
Pharmacy Helpdesk
Envision RxOptions
04.2016 - 09.2018
Humana Member Services
Convey Health Solutions
03.2015 - 02.2016
High School Diploma -
Sheridan Technical College
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