Daniel Mckenzie
Orlando,FL
Summary
To obtain a long-term position where I can advance my skills and acquire new knowledge within an organization as a Customer Service Representative. Customer Service Representative bringing top-notch skills in oral and written communication, active listening and analytical problem-solving skills. Enhances customer experiences by employing service-oriented behaviors, understanding customer desires, ad providing customized solutions to build loyalty.
Overview
9
9
years of professional experience
Work History
PA Specialist
OPTUMRX
11.2023 - 07.2024
- Received and processed prior authorizations according to established criteria and guidelines
- Managed incoming calls and faxes for prior authorizations, successfully researching and resolving associated benefit complications.
- Addressed and resolved customer issues in a timely fashion
- Assisted with various assignments directed by superiors.
Prior Authorization Specialist
careviso
03.2022 - 10.2023
- Executed Prior Authorization processing including insurance verification and investigations while also submitting appeals.
- Managed the processing of diagnostic labs for molecular and genetic analysis using multiple lab facilities such as Quest and LabCorp.
- Utilized knowledge from previous experience to adhere to lab SOP's while performing billing and processing duties.
- Utilized computer and phone skills effectively within multiple portals including Anthem(digital/electronic).
- Expertly addressed customer service needs of healthcare facilities and physicians
- Utilized clinic diagnosis paperwork to input PA requests correctly by verifying the appropriate procedure code (CPT), diagnosis, and description.
Tech Coach
ASURION
04.2023 - 10.2023
- Evaluated and resolved customer issues efficiently
- Implemented efficient solutions to address identified technical concerns with clarity and courtesy
- Effectively sold Verizon Home Device Protection services while adeptly troubleshooting smart home and other products in every customer interaction
Intake PA Specialist
CVS
11.2022 - 02.2023
- Successfully completed PA Submissions within tight deadlines in a highly regulated, deadline-oriented environment.
- Ensured completeness and accuracy of fax contents during review.
Clinical RPhT
Magellan Rx Management
01.2021 - 02.2022
- Demonstrated positive team environment through advocacy and reinforcement
- Reviewed and sanctioned approval of telephonic auth requests received from prescribers, applying client clinical standards.
- Provided clear communication about selected prior authorization criteria, pharmacy benefit coverage, and formulary alternatives to physicians and medical management staff
- Directed requests requiring extensive clinical review or denial to Pharmacist
- Maintained client service levels by monitoring telephone systems and adjusting staffing as needed.
Pharmacy Technician
Envolve Pharmacy
11.2020 - 12.2021
- Enhanced efficiency in handling coverage determination requests by accurately evaluating the need for pharmacist review.
- Maintained accurate documentation of coverage determination request decisions in the PBM system, promptly informing providers and members.
- Addressed client inquiries about authorization approvals and PBM online applications promptly.
- Streamlined process of referring specialty drug coverage determination requests to designated vendors or clients.
- Informed physicians, providers, and members about coverage determination request outcomes.
Pharmacy Technician
Walgreen Pharmacy Service
01.2018 - 10.2020
- Managed prescription exceptions by proactively reaching out to members and physicians, effectively resolving claim rejections.
- Ensured the precise input of members demographics and prescription information into our secured processing system
- Demonstrated problem-solving skills by researching and rectifying rejected insurance billing problems, while also addressing escalated member matters.
- Provided direction on processing prescription-related inquiries to pharmacists, ensuring accurate interpretation and efficient handling by pharmacies.
Representative
Interactive Response Technologies, IQOR
09.2015 - 12.2017
- Achieved efficient, accurate and timely input of consumers' information.
- Demonstrated efficient problem-solving skills by researching and troubleshooting consumers' issues using various systems.
- Cautiously handled web navigation, data computation, and confidential customer details to protect account integrity.
- Provided support for resolving issues related to credit card authorizations
- Provided support to consumers by phone, email, and online chat channels to resolve queries and alleviate concerns.
- Sought assistance from a supervisor when necessary and suitable.
Education
License #81586 - Pharmacy Technician
Florida Department of Health
Orlando, FL01.2018
High School Diploma -
Miami Carol City Senior High
06.2010
Skills
- Microsoft Office
- Microsoft Word
- Data Entry
- Time Management
- Multitasking and Organization
- Customer Service
- Strong Work Ethic
Timeline
PA Specialist
OPTUMRX
11.2023 - 07.2024
Tech Coach
ASURION
04.2023 - 10.2023
Intake PA Specialist
CVS
11.2022 - 02.2023
Prior Authorization Specialist
careviso
03.2022 - 10.2023
Clinical RPhT
Magellan Rx Management
01.2021 - 02.2022
Pharmacy Technician
Envolve Pharmacy
11.2020 - 12.2021
Pharmacy Technician
Walgreen Pharmacy Service
01.2018 - 10.2020
Representative
Interactive Response Technologies, IQOR
09.2015 - 12.2017
License #81586 - Pharmacy Technician
Florida Department of Health
High School Diploma -
Miami Carol City Senior High