DOREEN GILLIARD
Boynton Beach,FL
Summary
Efficient billing professional. Productive and diligent with passion for resolving discrepancies through attention to detail and creative problem-solving. Passionate about perpetuating company values through impeccable work ethic and drive.
Overview
18
18
years of professional experience
1
1
Certification
Work History
Billing Representative
Nyu Langone
08.2022 - Current
- Perform daily tasks in assigned work queues.
- Coordinated with intermediate parties to obtain payments and resolve issues.
- Submits authorization/precertification requests with insurance companies.
- Communicate with providers, patients, coders, or other responsible persons to ensure claims are correctly processed by third party payers.
- Utilize CBO pathways for determining actions needed to resolve authorizing procedures using payer websites ,billing systems information training within expected timeframe.
Pharmacy Technician
CVS Caremark
06.2020 - 08.2022
- Double-checked customer orders and information before filling out order forms to prevent unnecessary delays and errors.
- Processed and handled customer complaints, answering questions and providing alternative solutions.
- Contacted customers to collect payments and verify or add to existing information, consistently providing timely, accurate and customer-oriented service.
- Worked well in a team setting, providing support and guidance.
- Worked effectively in fast-paced environments.
- Skilled at working independently and collaboratively in a team environment.
- Managed time efficiently in order to complete all tasks within deadlines during Inbound and outbound calls
- Informed customers by mail or telephone of order information such as unit prices, shipping dates and anticipated delays.
Prior Authorization Specialist
Aetna, A CVS Health
08.2019 - 04.2020
- Input all patient data regarding claims and prior authorizations into system accurately.
- Verified eligibility and compliance with authorization requirements for service providers.
- Analyzed medical records and other documents to determine approval of requests for authorization.
- 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.
- Managed over %0 inbound calls per day
Billing Representative
Lakeworth Pharmacy
09.2018 - 02.2019
- Reviewed and solved account and billing discrepancies.
- Assessed accounts for payment status and reached out to customers.
- Coordinated with intermediate parties to obtain payments and resolve issues.
- Worked effectively with medical payers such as Medicare, Medicaid, commercial insurances to obtain timely and accurate payments.
- Set up and modified patient profiles in Abacus to include current information such as medications and insurance details
Patient Coordinator
Glades Drugs
11.2015 - 08.2018
- Provided complete patient assessments and communicated with patients to understand medical histories.
- Managed wide variety of customer service and administrative tasks to resolve customer issues quickly and efficiently (considered employee of the month)
- Supported company in maintaining work environment focused on quality, communication, collaboration and integration.
- Assessing whether employees need training to prevent mistakes during production
Pharmacy Technician
Primrose Pharmacy
04.2014 - 10.2015
- Answered incoming phone calls and addressed questions from customers and healthcare providers.
- Calculated dosage, filled prescriptions, and prepared prescription labels with absolute accuracy.
- Solved customer problems in-person or over telephone by providing assistance with placing orders, navigating systems, and locating items.
- Stocked, labeled, and inventoried medication to keep accurate records.
- Billed compound medications, DME equipment and Diabetic supply for preparations.
Pharmacy Technician
Rite Aid Pharmacy
08.2011 - 10.2013
- Entered and processed patients' prescriptions into internal system.
- Assisted pharmacist by filling prescriptions for customers and responding to patient questions regarding prescription and medication-specific issues.
- Collected co-payments or full payments from customers.
- Maintained proper drug storage procedures, registries, and records for controlled drugs.
- Consulted with insurance company representatives to complete claims processing, resolve concerns, and reconcile payments.
- Restocked pharmacy shelves with current merchandise to drive consistent peripheral sales.
- Ordered medicines daily to replenish stock and increase inventory in anticipation of need.
Pharmacy Technician Intern.
Jacobi Medical Center Hospital
02.2011 - 04.2011
- Prepared intravenous solutions, admixtures, respiratory drugs and other solutions using aseptic techniques.
- Restocked automated medication dispensing equipment
- Carried laboratory specimens, narcotics to appropriate departments.
- Identified process improvements in the day-to-day functioning of the department.
Medical Asst. Intern
Obstetrics and Gynecology
11.2006 - 01.2007
- Welcomed patients and inquired about wellbeing since last treatment.
- Prepared exam and treatment rooms for patient visits, availing all necessary supplies and equipment.
- Assisted with routine checks and diagnostic testing by collecting and processing specimens.
- Recorded Vital signs and taken medical history.
Education
Associate of Science - Pharmacy Technician
Monroe College
Bronx, NYBachelor of Science - Health Services Administration
Monroe College
Bronx, NYSkills
- Experience software Pioneer,Digital Rx, PK, Computer Rx, Abacus, QRS1, CRM & SDA-Epic
- Assisting with physical exams
- Medication Inventory Management
- Auditing
- Quality Assurance Controls
- Healthcare billing
- Team building
- Medical & Pharmaceutical Terminology
- Adaptability
- Training and Development
- Analytical and Critical Thinking
- Insurance Verification
Accomplishments
- Processed more than 30+ prescriptions on average each day as a Pharmacy Technician.
- Directly supervised Pharmacy Technicians, interns and support staff.
- Exceptional attention to detail
Certification
- Registered License Pharmacy Technician
- Medical Assistant Certification
Timeline
Billing Representative
Nyu Langone
08.2022 - Current
Pharmacy Technician
CVS Caremark
06.2020 - 08.2022
Prior Authorization Specialist
Aetna, A CVS Health
08.2019 - 04.2020
Billing Representative
Lakeworth Pharmacy
09.2018 - 02.2019
Patient Coordinator
Glades Drugs
11.2015 - 08.2018
Pharmacy Technician
Primrose Pharmacy
04.2014 - 10.2015
Pharmacy Technician
Rite Aid Pharmacy
08.2011 - 10.2013
Pharmacy Technician Intern.
Jacobi Medical Center Hospital
02.2011 - 04.2011
Medical Asst. Intern
Obstetrics and Gynecology
11.2006 - 01.2007
Associate of Science - Pharmacy Technician
Monroe College
Bachelor of Science - Health Services Administration
Monroe College
- Registered License Pharmacy Technician
- Medical Assistant Certification
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