Crystal Tucker
Las Vegas,NV
Summary
Highly organized and detail-oriented professional with a passion for executing exceptional events that consistently achieve established goals. Demonstrated expertise in planning, and coordinating a wide variety of both small-scale and large-scale events. Strong communicator with excellent public speaking skills, adept at effectively conveying key messages to diverse audiences.
Overview
22
22
years of professional experience
1
1
Certification
Work History
Team Lead, Prior Authorizations
Asembia
12.2022 - Current
- Effectively manage the team to accomplish daily tasks
- Direct workflow and assignments as needed
- Answers team member questions, help with team member problems, and oversees team member work for quality and guideline compliance
- Monitor quality and performance of the team and demonstrate the ability to provide feedback in an effective manner that drives change in behavior and results
- Receive and effectively route program “referrals” (prescriptions)
- Interface with programmers as needed to address any system difficulties
- Communicate with internal contacts, manufacturers, insurance companies, pharmacies and patients to achieve program goals
- Attend manufacturer meetings to support ongoing program development
- Effectively train or re-train team members
- Identify training needs and provide coaching
- Establish effective rapport with other employees, clients, physicians, pharmacies and clients
- Supports team manager and performs management duties when manager is absent or out of office
- Conducted regular progress reviews with individual team members to identify areas for improvement and provide guidance on career development opportunities.
- Established clear performance metrics for the team which helped in tracking progress towards set targets effectively.
- Increased customer satisfaction by ensuring timely completion of projects and adherence to high-quality standards.
Field Service Liaison, Prior Authorization Patient Care Coordinator
Asembia
05.2021 - Current
- Research patients accounts and provide updates to FAL's from pharmaceutical manufacturer on current prior authorization status's
- Acquire a thorough understanding of the program business rules
- Actively engage employees, clients, prescribers, and pharmacies to proactively solve problems and addressing any questions in a timely manner
- Escalate issues to appropriate management for resolution
- Orchestrated weekly meetings with FAL's to follow up on actionable items that need to be addressed with MDO
- Maintain a high level of quality while maintaining company expectations for production
- Responsible for completing tasks in a timely manner
- Make outbound calls to insurance companies to obtain updates on prior authorization statuses in addition to correct processing information
- Responsible for providing excellent customer service over the phone for members, pharmacy
- Maintain professional competence, knowledge and skills necessary to effectively and accurately complete Medicaid and Commercial prior authorizations
- Communicate with nurses, doctors and other medical professionals via phone to gather correct information to ensure proper processing of prior authorizations
- Provided pertinent information to member, pharmacies and providers regarding but not limited to approvals, denied claims
- Obtain updates from multiple insurance companies on status of pending prior authorizations
- Obtain information for processing prior authorizations for patients from insurance companies
- Maintained a level of productivity suitable for the department
- Compliance with the provisions of the Health Accountability Act of 1996 and its implementing regulations
Prior Authorization Technician
IngenioRx(Anthem BC)
02.2020 - 05.2021
- Responsible for providing excellent customer service over the phone for members, pharmacies, and providers
- Maintain professional competence, knowledge, and skills necessary to effectively and accurately complete Medicaid and Commercial prior authorizations
- Communicate with nurses, doctors, and other medical professionals via phone to gather correct information to ensure proper processing of prior authorizations
- Provided pertinent information to member, pharmacies and providers regarding but not limited to approvals, denied claims
- Analyze faxed requests and documentation to determine coverage and approval utilizing criteria provided
- Strong understanding of HIPAA
- Maintained a level of productivity suitable for the department
Front End Pharmacy Technician/Trainer
OptumRx Mail Order Pharmacy
10.2014 - 02.2020
- Completed Principles of Effect Training Course
- Facilitated several training classes via WebEx
- Assisted in new hire classes as a POET to the trainer
- Trained classes on site, out of state and overseas
- Transitioned to processing specialty medications
- Trained to take inbound calls from doctor's office to resolve orders that require clarification
- Organize and track all updates regarding processes and new or changing drugs
- Responsible for processing 120 daily prescriptions and patients orders of nation's 2nd largest mail order pharmacy; maintain 99.89% accuracy when transcribing doctor instructions, medicine data, and patient information
- Accurately update sensitive patient medical and personal information, record changes in pharmacy database; utilize information to provide accurate medical instruction to end users
- Provide excellent customer service via phone and email, assist customers with medical, pharmacy, shipping and payment questions; received 100% satisfaction rate on customer service calls
- Communicate with doctors and other medical professionals via phone and email to gather correct information, ensure proper instructions, confirm strength, quantity, and dosage form, and comply with federal and state regulations
- Participate in multiple “Pilot Programs” for new systems and processing procedures; test updated database software, document, and report errors, and meet with program manager to provide user feedback
- Completed Principles of Effect Training Course
Turner's Classic Dogs
Self-employed
04.2010 - 10.2015
- Managed daily operations for a successful small business, ensuring efficient processes and quality services.
- Promoted business via social media to generate leads and maximize brand identity.
- Enhanced company reputation by consistently delivering exceptional service quality to customers.
- Created financial plans and budgets to optimize resources, track expenses, and ensure profitability.
- Expanded client base through targeted networking initiatives, resulting in increased sales opportunities.
- Participated actively in local community events or organizations as a way to give back while expanding brand visibility and credibility.
- Implemented cost-saving measures without compromising on product or service quality.
- Negotiated favorable lease terms for business expansion, securing prime location at reduced cost.
- Ensured a memorable event for clients by creating personalized and themed party environments.
- Maintained cleanliness standards throughout events to provide an inviting environment for guests while adhering to health codes.
- Planned parties according to customer specifications.
Pharmacy Technician
CVS Pharmacy
06.2014 - 10.2014
- Assisted over 60 phone, walk up, and drive thru customers daily; process new and refill prescriptions, create new patient accounts, and update customer information in pharmacy database
- Manned pharmacy cash drawer, processing over $1000 in cash and card transactions in an average shift; handled customer refunds, and store and manufacturer coupons
- Liaised directly with doctors, clarify prescription information including patient directions, quantity, date, and strength; communicated with health insurance companies to verify patient coverage and authorize medications
- Worked with patients on various insurance and billing issues, special ordering of medication, and instructions for proper administration of prescriptions
- Rebilled and reissued patient prescriptions; updated quantity and types of medication in pharmacy database and started billing or refund process with patient's insurance company
- Processed daily inventory of pharmacy; received deliveries, checked incoming products with orders, restocked medications, processed and properly disposed of expired drugs, and ordered new stock
Licensed Sales Insurance Agent
GEICO
01.2003 - 12.2009
- Processed over 45 incoming calls for auto, motorcycle, and home insurance quotes per shift; maintained call quality score of over 90% and ranked within top 5 of team for all 6 years
- Met daily, monthly, and yearly goals for sales and call metrics; earned top 3 sellers rank, closed 7 sales daily, kept call times within internal standards, and received over 90% quality scores on monitored calls
- Approached by department leadership to participate in multiple “Pilot Programs” due to past sales success and reliability on phones; experimented with reducing call times from 15 to 5 minutes
- Participated in continuing education for internal and federal licenses; maintained insurance licenses in 35 states
- Trained new sales agents on building rapport with customers, tone and delivery, phone sales, and internal systems and applications; call shadowed and mentored new employees through probationary period
Education
High School -
Southwest Senior High School
San Diego, CA06.2000
Pharmacy Technician Vocational Certificate -
Grossmont Health Occupations
San Diego, CA01.2014
Skills
- Meticulous Attention To Detail
- Proficient in Microsoft Office
- Effective Conflict Resolution
- Proficient in Excel
- Client Relationship Management
- Proficient in Word
- Effective Client Communication
- PowerPoint
- Proficient Task Distribution
- Strategic planning
- Team Engagement Initiatives
- Team Leadership
Certification
- Pharmacy Technician, NV
- Certified Pharmacy Technician
Timeline
Team Lead, Prior Authorizations
Asembia
12.2022 - Current
Field Service Liaison, Prior Authorization Patient Care Coordinator
Asembia
05.2021 - Current
Prior Authorization Technician
IngenioRx(Anthem BC)
02.2020 - 05.2021
Front End Pharmacy Technician/Trainer
OptumRx Mail Order Pharmacy
10.2014 - 02.2020
Pharmacy Technician
CVS Pharmacy
06.2014 - 10.2014
Turner's Classic Dogs
Self-employed
04.2010 - 10.2015
Licensed Sales Insurance Agent
GEICO
01.2003 - 12.2009
High School -
Southwest Senior High School
Pharmacy Technician Vocational Certificate -
Grossmont Health Occupations
Similar Profiles
Heather AndersonHeather Anderson
Patient Coordinator at AsembiaPatient Coordinator at Asembia
Ruba A. JudehRuba A. Judeh
Regional Account Manager at AsembiaRegional Account Manager at Asembia
EBONY JENKINSEBONY JENKINS
Patient Care Coordinator at AsembiaPatient Care Coordinator at Asembia