Chelsea Merwin
Sachse,TX
Summary
Amiable Prior Authorization Representative with 8 years of connecting patients and healthcare providers to vital resources. Dedicated to executing on prescribed medical funding guidelines and policies. Maintains compassionate and sympathetic relations with consumers. Adept at balancing business interests with human-centric service models.
Overview
18
18
years of professional experience
1
1
Certification
Work History
Prior Authorization Technician
Apex Systems
08.2023 - Current
- Verified eligibility and compliance with authorization requirements for service providers.
- Fielded telephone inquiries on authorization details from plan members and medical staff.
- Prepared and distributed denial letters, detailing reasons for denial and possible appeal measures.
- Maintained strict confidentiality in accordance with HIPAA regulations while handling sensitive patient information during the prior authorization process.
- Facilitated communication between patients, pharmacists, and medical staff to resolve insurance-related issues quickly and effectively.
- Managed a high volume of prior authorization requests, consistently meeting deadlines while maintaining attention to detail.
- Responded to inquiries from healthcare providers regarding prior authorization requests.
- Evaluated clinical criteria for approval or denial of services requiring pre-authorization.
Pharmacy Technician
Kroger
01.2020 - 05.2024
- Supports pharmacological services by stocking, assembling, and distributing medications
- Solved customer problems in-person or over telephone by providing assistance with placing orders, navigating systems, and locating items.
- Helped pharmacist clear problematic prescriptions and address customer questions to keep pharmacy efficient.
- Maintained accurate inventory levels for efficient pharmacy operations and cost control.
- Collected co-payments or full payments from customers.
- Worked with computerized and automated systems for dispensing medications and editing new patient profiles.
- Communicated directly with doctors offices via telephone, fax and email.
- Streamlined pharmacy operations through effective organization of supplies, workspace layout optimization, and process improvements.
- Developed a systematic approach to organize medications, reducing errors and improving efficiency in the workflow.
- Helps health care providers and patients by greeting them in person and by phone, answering questions and requests, and referring inquiries to the pharmacist.
- Trained new pharmacy technicians on proper procedures and best practices, ensuring consistent quality of service.
- Stocked, labeled, and inventoried medication to keep accurate records.
- Completed paperwork, entering prescription and insurance or billing information into patient profiles.
- Enhanced patient care by accurately filling and dispensing prescriptions in a timely manner.
- Consulted with insurance company representatives to complete claims processing, resolve concerns, and reconcile payments.
- Increased customer satisfaction by delivering friendly, personalized service during transactions.
Pharmacy Technician
CVS
01.2017 - 01.2020
- Answered incoming phone calls and addressed questions from customers and healthcare providers.
- Stocked, labeled, and inventoried medication to keep accurate records.
- Enhanced pharmacy workflow by assisting pharmacists with medication dispensing, labeling, and packaging.
- Calculated dosage, filled prescriptions, and prepared prescription labels with absolute accuracy.
- Promoted patient confidentiality by adhering to HIPAA regulations when handling personal information during transactions.
- Solved customer problems in-person or over telephone by providing assistance with placing orders, navigating systems, and locating items.
- Counted and labeled prescriptions with correct item and quantity.
- Assisted in maintaining a clean and organized work environment, ensuring compliance with safety regulations.
- Increased overall pharmacy productivity by restocking supplies, organizing shelves, and maintaining cleanliness according to standards.
- Assisted pharmacist by filling prescriptions for customers and responding to patient questions regarding prescription and medication-specific issues.
- Performed wide range of pharmacy operations with strong commitment to accuracy, efficiency and service quality.
- Provided exceptional customer service, fostering positive relationships with both new and returning patients at the pharmacy counter.
- Improved patient satisfaction by efficiently processing prescriptions and managing inventory in a timely manner.
- Entered and processed patients' prescriptions into internal system.
- Performed various pharmacy operational activities with strong commitment to accuracy, efficiency, and service quality.
- Consulted with insurance company representatives to complete claims processing, resolve concerns, and reconcile payments.
- Assisted in training new team members on standard operating procedures to ensure consistent quality of service across the entire team.
- Maximized pharmacy efficiency through effective communication with staff members and adherence to procedures.
- Communicated with patients to collect information about prescriptions and medical conditions or arrange consultations with pharmacists.
- Trained new pharmacy technicians on proper procedures and best practices, ensuring consistent quality of service.
- Completed paperwork, entering prescription and insurance or billing information into patient profiles.
- Enhanced patient care by accurately filling and dispensing prescriptions in a timely manner.
- Increased customer satisfaction by delivering friendly, personalized service during transactions.
- Helped pharmacist clear problematic prescriptions and address customer questions to keep pharmacy efficient.
- Maintained accurate inventory levels for efficient pharmacy operations and cost control.
- Worked with computerized and automated systems for dispensing medications and editing new patient profiles.
- Collected co-payments or full payments from customers.
Mobile Sales Representative
MarketSource
01.2017 - 01.2019
- Established strong relationships with clients, fostering long-term loyalty and repeat business.
- Managed inventory efficiently, ensuring adequate stock levels to meet customer demand without excess waste.
- Boosted customer satisfaction by promptly addressing inquiries and providing knowledgeable product information.
- Organized promotional events to generate interest in products, driving increased foot traffic and sales conversion rates.
- Resolved customer complaints professionally, turning potentially negative situations into opportunities for positive growth.
- Assisted in training new hires, sharing expertise for their professional development and overall team success.
- Streamlined store operations by implementing efficient processes for improved productivity and time management.
- Leveraged CRM tools to track leads, manage follow-ups, and analyze data for informed decision-making regarding marketing tactics or inventory adjustments.
- Cultivated a welcoming store environment that encouraged customers to explore products at their leisure while remaining available for assistance when needed.
- Exceeded sales targets consistently by effectively identifying customer needs and matching them with appropriate products.
- Participated in weekly sales meetings to discuss performance metrics, set goals, and identify areas for improvement or opportunity.
- Maintained up-to-date knowledge of industry trends and competitor offerings, positioning products strategically in the market.
- Maximized revenue through upselling techniques and persuasive communication skills during sales presentations.
- Monitored wireless sales space to establish familiarity with various carriers.
Electronics Team Member
Target Corporation
08.2006 - 11.2016
- Offered each customer top-notch, personal service to boost sales and customer satisfaction.
- Coordinated restocking of sales floor with current merchandise and accurate signage for current promotions.
- Increased customer satisfaction by providing knowledgeable assistance and personalized recommendations for electronics purchases.
- Maintained a clean, organized, and visually appealing sales floor, ensuring an enjoyable shopping experience for customers.
- Applied knowledge of electronics products to educate prospects and customers.
- Utilized highly developed interpersonal and people skills to approach customers and engage in conversations.
- Checked pricing, scanned items, applied discounts, and printed receipts to ring up customers.
- Handled customer inquiries and resolved issues promptly, demonstrating strong problem-solving skills and dedication to customer service excellence.
- Developed rapport with repeat clients by remembering personal preferences and delivering consistently exceptional service experiences.
- Greeted customers, helped locate merchandise, and suggested suitable options.
- Located merchandise across various stores to address customer needs.
- Identified and resolved complex issues by applying advanced analytical and troubleshooting strategies.
- Stayed up-to-date on the latest industry trends and technology advancements, enabling informed conversations with customers about various products.
- Assisted in inventory management, accurately tracking stock levels and placing orders as needed to maintain optimal product availability.
- Increased sales and customer satisfaction through personalized servicing.
- Stayed up-to-date on current promotions, sales, and special events to impart such information to customers.
Education
Bachelor of Science - Business Management
University of Phoenix
Dallas, TX12.2022
A.S Degree - General Science
Collin College
05.2016
Skills
- Data entry proficiency
- Microsoft Excel
- Microsoft Outlook
- Workflow Optimization
- Critical thinking abilities
- Claims Processing
- Problem-solving skills
- Healthcare Industry Knowledge
- Retail knowledge
- Active Listening
- Call center experience
- Conflict Resolution
Certification
- Marketing Certification, University of Phoenix, 01/01/22
- PTCB Certified, 30095469
Licensing
Texas State Board of Pharmacy, 275172
Timeline
Prior Authorization Technician
Apex Systems
08.2023 - Current
Pharmacy Technician
Kroger
01.2020 - 05.2024
Pharmacy Technician
CVS
01.2017 - 01.2020
Mobile Sales Representative
MarketSource
01.2017 - 01.2019
Electronics Team Member
Target Corporation
08.2006 - 11.2016
Bachelor of Science - Business Management
University of Phoenix
A.S Degree - General Science
Collin College
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