Danielle Martin
Greensboro,NC
Summary
Dedicated Prior Authorization Tech committed to ensuring all vital requests and documents are processed. Diligently tracks patient outcomes and considers caretaker feedback. Incorporates empathetic communications and professional best practices to satisfy plan members and achieve business goals.
Overview
10
10
years of professional experience
1
1
Certification
Work History
Senior Prior Authorization Technician
Optum
10.2023 - Current
- Verified eligibility and compliance with authorization requirements for service providers.
- Maintained strict confidentiality in accordance with HIPAA regulations while handling sensitive patient information during the prior authorization process.
- Evaluated and updated internal prior authorization protocols as needed, maintaining compliance with evolving industry standards.
- Reduced turnaround time for prior authorization approvals with thorough documentation and timely follow-ups with internal clinicians
- Decreased claim denials by ensuring all required documentation was submitted accurately and promptly for each case under review.
- Boosted revenue by securing reimbursements through well-prepared prior authorization submissions that adhered to insurer guidelines.
- Triaged unscheduled and emergency authorizations, directing submissions to appropriate personnel for rapid response.
- Fielded telephone inquiries on authorization details from plan members and medical staff under formulary look up and trial claims
- Distributed denial letters, detailing reasons for denial and possible appeal measures.
- 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.
- Input all patient data regarding claims and prior authorizations into system accurately.
- Provided prior authorization support for physicians, healthcare providers and patients in accordance with payer guidelines.
- Evaluated clinical criteria for approval or denial of services requiring pre-authorization.
Certified Clinical Pharmacy Technician
Cone Health Transitions Of Care
06.2022 - 09.2024
- Applied changes to medication dose in response to available inventory
- Communicate with case managers and patient advocates to assist patients in accessing patient discount programs
- Transmit messages to unit staff to ensure prompt pharmacy services for patient discharge
- Receive, count, and monitor inventory management and 340B
- Serve as a preceptor for pharmacy students and interns
- Perform medication reconciliation
- Building relationships between the pharmacy and hospital staff to correlate effective discharges
- Assist and support pharmacist in daily duties
- EPIC, WAM and Accounts Receivable expert
- Float along the Cone Health Community pharmacies
- Initiated patient prior authorizations along each pharmacy chain
- Conducted thorough medication reviews to identify and resolve discrepancies, preventing potential errors.
- Enhanced patient safety through diligent monitoring of drug therapy for potential adverse effects and interactions.
- Implemented best practices in aseptic compounding techniques, maintaining the highest standards of safety for patients receiving parenteral medications.
- Provided support during medication-related emergencies, applying critical thinking skills and clinical expertise to mitigate potential risks.
- Improved patient outcomes by accurately interpreting medication orders and dispensing medications in a timely manner.
- Facilitated transitions of care by coordinating closely with discharge planners and other members of the healthcare team, ensuring seamless continuity of medication therapy services across settings.
- Performed various pharmacy operational activities with strong commitment to accuracy, efficiency, and service quality.
- Answered incoming phone calls and addressed questions from customers and healthcare providers.
- Consulted with insurance company representatives to complete claims processing, resolve concerns, and reconcile payments.
- Ordered medicines daily to replenish stock and increase inventory in anticipation of need.
- Collected co-payments or full payments from customers.
- Helped pharmacist clear problematic prescriptions and address customer questions to keep pharmacy efficient.
- Coordinated with physicians and insurance agency representatives for speedy resolution of prescription discrepancies.
Certified Pharmacy Technician
Wal-Mart
05.2018 - 08.2023
- Coordinated filling of 450+ daily prescriptions in high-volume retail pharmacy environment
- Set up and modified patient profiles including current medications allergies and insurance in Connexus
- Solved customer problems in-person and by phone, providing assistance with navigating and placing orders
- Completed paperwork, entering prescription and insurance or billing information into patient profiles
- Assisted in preparation, distribution, and storage of pharmaceuticals
- Counted, measured, and compounded medications following standard procedures
- Communicated with prescribers to verify medication dosages, refills, prior authorizations and patient information
- Maintained drug inventory levels by ordering necessary medications and supplies
- Worked with computerized and automated systems for dispensing medications and editing new patient profiles
- Resolved non-routine issues like third-party billing, computer system and customer service issues
- Maintained proper drug storage procedures, registries, and records for controlled drugs
- Consulted with insurance representatives to complete claims processing, resolve concerns and reconcile payments
Customer Service Supervisor
Wal-Mart
03.2015 - 05.2018
- Coached and developed over 30 cashiers on the front end
- Identify and resolve customer complaints or issues
- Effectively use money machine to dispense cash throughout the store registers and audit
Education
General Studies
GTCC
Greensboro, NC01.2014
Skills
- Genesys Knowlegde
- Problem-solving skills
- Patient confidentiality
- Pharmacology
- Quality assurance and control
- Medical terminology knowledge
- Multitasking ability
- Critical Thinking
- Resourcefulness
- Networking skills
- Detail orientation
Certification
Certified Pharmacy Technician (CPhT), Pharmacy Technician Certification Board
Timeline
Senior Prior Authorization Technician
Optum
10.2023 - Current
Certified Clinical Pharmacy Technician
Cone Health Transitions Of Care
06.2022 - 09.2024
Certified Pharmacy Technician
Wal-Mart
05.2018 - 08.2023
Customer Service Supervisor
Wal-Mart
03.2015 - 05.2018
General Studies
GTCC
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