ERIKA TOVAR
Los Angeles,CA
Summary
Experienced and bilingual healthcare administrative specialist with over a decade of progressive experience in utilization management, insurance coordination, and pharmacy operations. Adept at processing prior authorizations, performing eligibility and benefit verifications, and providing non-clinical support for patient care coordination in high-volume environments. Highly skilled in navigating EMRs and payer portals, documenting accurately for compliance with NCQA and HIPAA standards, and supporting denial management and appeals. Reliable, detail-oriented, and able to work independently in fast-paced remote or in-person settings. Efficient Authorization Specialist with comprehensive knowledge of medical insurance policies, coding, and procedures. Demonstrated ability to liaise effectively between patients, healthcare providers, and insurance companies for smooth transactions. Strengths include strong problem-solving skills, thoroughness in documentation and a keen eye for identifying inconsistencies. Proven impact in previous roles includes streamlined authorization processes, improved patient satisfaction rates, and reduced claim denials.
Overview
13
13
years of professional experience
1
1
Certification
Work History
Referral Authorization Specialist
Cedars-Sinai Huntington Cancer Center
Pasadena, CA
07.2022 - Current
- Process high-volume incoming referrals and prior authorization requests in Epic/CS-Link across multiple insurance types, including Medicare, Medi-Cal, HMO, and PPO plans.
- Evaluate clinical criteria against payer-specific medical policies to initiate and complete authorization workflows for oncology, neurology, and dermatology patients.
- Manage financial assistance programs, EPAs, and copay aid for outpatient prescriptions.
- Conduct detailed eligibility checks, track referral statuses, and document all communications to maintain compliance with HIPAA and NCQA standards.
- Coordinate with payers for peer-to-peer review scheduling and follow up on retroactive approvals and claim appeals.
- Facilitate daily huddles with the care coordination team to align on escalations, referral volume, and productivity targets.
- Utilize multiple systems (insurance portals, Excel trackers, Docu-track) to cross-reference approvals and maintain workflow accuracy.
Prior Authorization Specialist
Beverly Hills Cancer Center
Beverly Hills, CA
02.2021 - 07.2022
- Submitted and tracked prior authorizations for oral chemotherapy and specialty medications using QS1 and payer platforms.
- Interpreted clinical documentation and drug protocols from package inserts to determine authorization requirements and initiate case reviews.
- Verified benefits and eligibility coverage with health plans for oncology patients to reduce risk of treatment delays.
- Collaborated with providers, pharmacists, and infusion teams to ensure accurate and timely medication access.
- Supported resolution of benefit denials by gathering and submitting appeal documentation.
- Documented all authorization steps to ensure consistency with NCQA compliance and internal audit readiness.
Specialty Pharmacy Technician
Evergreen Medico Pharmacy
Santa Monica, CA
08.2020 - 01.2021
- Processed specialty pharmacy claims and prior authorizations for oncology and autoimmune therapies.
- Conducted benefit verification with commercial and IPA networks, and managed documentation in Prime RX and Cerner Etreby.
- Assisted patients with enrollment in pharmaceutical-sponsored patient assistance programs to reduce out-of-pocket costs.
- Maintained ongoing communication with physicians, insurance reps, and patients to support the continuum of care and avoid medication access delays.
Pharmacy Technician – HIV/HEP C Unit
Kroger Specialty Pharmacy
Los Angeles, CA
11.2019 - 06.2020
- Handled prior authorizations and medication access support for HIV and Hepatitis C patients.
- Processed claims through public programs including ADAP, Medi-Cal, LA Care, and used CoverMyMeds for electronic submissions.
- Coordinated with internal case managers to gather clinical documentation and support approvals for high-cost medications.
- Participated in internal projects to train peers on copay assistance processes, enhancing staff efficiency and patient outcomes.
Pharmacy Support Specialist
Cedars-Sinai – The Angeles Clinic
Los Angeles, CA
07.2016 - 07.2019
- Supported a physician-dispensing oncology clinic by managing EMR charting and claim submission through QS1.
- Performed comprehensive eligibility checks, documented patient benefits, and assisted with prior authorization initiation.
- Used the Lynx inventory system to manage drug stock, restock investigational drugs, and resolve discrepancies in clinical research binders.
- Communicated with clinical teams regarding drug availability and payer authorization statuses.
Pharmacy Technician
Brown and Welin Pharmacy
Pasadena, CA
07.2015 - 07.2016
- Processed and filled prescriptions using RX30 while assisting with billing issues and resolving insurance rejections, including workers' compensation claims.
- Verified patient insurance and followed up on incomplete claims to ensure smooth medication dispensing.
Pharmacy Technician
MedicoRx Specialty Pharmacy
North Hollywood, CA
10.2014 - 07.2015
- Assisted long-term care facilities by filling bubble packs and maintaining dosage accuracy using CPR+ and Cerner Etreby.
- Worked closely with healthcare providers to maintain regulatory compliance and proper medication delivery.
Workflow Coordinator
Px Drugstore Modern Health
Los Angeles, CA
08.2012 - 08.2014
- Directed prescription processing workflows in a high-volume pharmacy using Docu-track and RX software.
- Verified insurance eligibility, collaborated with technicians and pharmacists to route prescriptions efficiently, and supported non-clinical documentation needs.
Education
Pharmacy Technician Certificate -
American Career College
Los Angeles, CA06.2012
High School Diploma -
Ulysses S. Grant High School
Valley Glen, CA06.2011
Skills
- Utilization Management Support
- Prior Authorization & Denial Avoidance
- Insurance Verification (HMO, PPO, Medicare, Medi-Cal)
- Non-Clinical Case Review Coordination
- EMR & Pharmacy Systems: Epic, Cerner, CS-Link, QS1, Docu-track
- Software: Microsoft Office Suite, Google Workspace, Excel Trackers
- Knowledge of HIPAA, NCQA, CPT, ICD-10
- Fluent in English & Spanish
- Typing: 45 WPM
- Healthcare Systems: Epic, Cerner, CS-Link, QS1, RX30, Prime RX, Digital RX, CPR, Docu-track
- Administrative Tools: Microsoft Office (Word, Excel, Outlook, PowerPoint), Google Workspace (Docs, Sheets, Calendar, Gmail)
- Insurance Portals: CoverMyMeds, Medi-Cal, LA Care, ADAP, Commercial Payer Sites
Certification
California Pharmacy Technician License, #123544
Technical Skills
Epic, Cerner, CS-Link, QS1, RX30, Prime RX, Digital RX, CPR+, Docu-track, Microsoft Office (Word, Excel, Outlook, PowerPoint), Google Workspace (Docs, Sheets, Calendar, Gmail), CoverMyMeds, Medi-Cal, LA Care, ADAP, Commercial Payer Sites
Timeline
Referral Authorization Specialist
Cedars-Sinai Huntington Cancer Center
07.2022 - Current
Prior Authorization Specialist
Beverly Hills Cancer Center
02.2021 - 07.2022
Specialty Pharmacy Technician
Evergreen Medico Pharmacy
08.2020 - 01.2021
Pharmacy Technician – HIV/HEP C Unit
Kroger Specialty Pharmacy
11.2019 - 06.2020
Pharmacy Support Specialist
Cedars-Sinai – The Angeles Clinic
07.2016 - 07.2019
Pharmacy Technician
Brown and Welin Pharmacy
07.2015 - 07.2016
Pharmacy Technician
MedicoRx Specialty Pharmacy
10.2014 - 07.2015
Workflow Coordinator
Px Drugstore Modern Health
08.2012 - 08.2014
Pharmacy Technician Certificate -
American Career College
High School Diploma -
Ulysses S. Grant High School
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