Summary
Overview
Work History
Education
Skills
Certification
Languages
Timeline
Generic

Demisha Jones

E. Rancho Dominguez,CA

Summary

Hardworking Prior Authorization Specialist with successful background working closely with insurance company representatives to gain preapproval for procedures and testing. Detail-oriented performer with over ten years of managing documentation. Considered team player with exemplary multitasking skills.

Overview

4
4
years of professional experience
1
1
Certification

Work History

Prior Authorization Specialist

Premier Infusion Pharmacy
09.2022 - 01.2024
  • Analyzed medical records and other documents to determine approval of requests for authorization.
  • Reviewed appeals for prior authorization requests and communicated with payers to resolve issues.
  • Collaborated with physicians to obtain necessary clinical information for prior authorization submissions.
  • Fielded telephone inquiries on authorization details from plan members and medical staff.
  • Researched denied claims and contacted insurance companies to resolve these issues.
  • Responded to inquiries from healthcare providers regarding prior authorization requests.

Customer Service Representative/DME Technician/

Home Medix
05.2021 - 09.2022
  • Calculated correct order totals, updated accounts, and maintained detailed records for inventory management.
  • Developed strong product knowledge to provide informed recommendations based on individual customer needs.
  • Implemented and developed customer service training processes.
  • Participated in cross-functional initiatives aimed at enhancing overall business operations and customer satisfaction levels.
  • Responded to customer requests, offering excellent support and tailored recommendations to address needs.
  • Investigated and resolved customer inquiries and complaints quickly.

Medical Customer Service Representative

Optum
09.2019 - 12.2019
  • Used computer programs and registration systems to schedule patients for routine and complex procedures.
  • Provided excellent customer care by responding to requests, assisting with product selection and handling ordering functions.
  • Enhanced patient satisfaction by addressing inquiries and resolving issues related to medical appointments, billing, and insurance.

Education

Pharmacy Technology Certification - Pharmacy Technology

Career Colleges of America - South Gate
South Gate, CA
05.2005

Skills

  • CPT coding knowledge
  • Understanding of insurance details
  • Prior Authorization Process
  • Retro-Authorizations
  • Understanding of medical terms
  • Electronic Health Records Proficiency
  • Prescription Coordination
  • Appointment Scheduling
  • Program knowledge

Certification

  • Licensed Pharmacy Technician - Pharmacy Technician Certification Board - 2005 - 2010

Languages

Spanish (some)
Limited Working

Timeline

Prior Authorization Specialist

Premier Infusion Pharmacy
09.2022 - 01.2024

Customer Service Representative/DME Technician/

Home Medix
05.2021 - 09.2022

Medical Customer Service Representative

Optum
09.2019 - 12.2019

Pharmacy Technology Certification - Pharmacy Technology

Career Colleges of America - South Gate

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Demisha Jones