Alicia L. Clark
Summary
Highly experienced healthcare professional with experience in managed care, pharmacy services, and sick/injury claims. Proficient in managing multiple tasks, optimizing customer service, and detailed documentation. Contributes to comprehensive efficiency by adhering to the strict standards of healthcare confidentiality and demonstrating excellent problem-solving skills
Overview
15
15
years of professional experience
Work History
Senior Approver
Elevance Health
Dearborn, MI
08.2022 - 03.2024
- Successfully managed over 100 disability claims which included investigation, substantiation, and documentation of claims as well as authorization of payment
- Effectively communicated with claimants, medical professionals, and other vendors
- Efficiently investigated and processed statutory, occupational, and non-occupational claims as well as claims that fall outside duration guidelines
Injury Claims Pharmacy Benefit Representative
Employee Health Insurance Management
Southfield, MI
06.2019 - 08.2022
- Assessed rejected pharmacy claims and approved requests for prior authorizations when applicable
- Proficiently reviewed incoming requests for payment of paper claims for medications and durable medical equipment
- Successfully collaborated with adjusters regarding claimant relations
- Efficiently managing inbound call queue
- Managed employee training on processes and procedures over 2 years while offering continuous advice and support
Clinical Pharmacy Technician Team Leader
Magellan Health Services
Troy, MI
09.2014 - 09.2018
- Efficiently processed all incoming prior authorization requests for Medicare plans while coordinating with members, provider's offices, and health plans to obtain all pertinent information and ultimately inform member and provider of outcome of prior authorization
- Assisted members and pharmacy staff with all issues billing pharmacy benefits
- Successfully managed a team of 5 associates on insurance plan policies, metrics, and customer service expectations while handling escalated issues and calls
- Closely worked with account manager to clarify plan details and requirements
Ambulatory Pharmacy Technician
Henry Ford Health System
Livonia, MI
01.2014 - 04.2014
- Effectively processed all new prescriptions and refills under directions of a pharmacists while resolving any third-party rejections; in addition, assisting in inventory control
- Assisted all customers in person and via phone
Insurance Verification Specialist
Walgreens Retail Pharmacy/Walgreens Specialty Pharmacy
Canton, MI
07.2009 - 01.2014
- Successfully verified all pharmacy benefits for new referrals while effectively resolving all third-party rejections and informing member of copay structures for specialty medication(s) requested, also responsible for assisting patients with copay assistance programs when appropriate
Education
Associate - Science/Radiology Technology
Schoolcraft College
02.2025
Certified Pharmacy Technician -
Washtenaw Community College
01.2010
Bachelor -
Eastern Michigan University
01.2007
Skills
- Managing drug utilization and compliance
- HIPAA Compliant
- Injury and disability claim management
- Efficiently adjudicating pharmacy claims
- Remarkable problem-solving
- Outstanding phone etiquette
- Data entry
- Team Lead
- 1CD-10
- Call center
- Customer service expert
- Over 10 years of pharmacy experience
- Successfully managing over 100 disability claims
- Scheduling medical appointments
- 10 years certified and licensed pharmacy technician
- CMS compliance
- Medicare
- Prior Authorizations Specialist
- Medical records
Timeline
Senior Approver
Elevance Health
08.2022 - 03.2024
Injury Claims Pharmacy Benefit Representative
Employee Health Insurance Management
06.2019 - 08.2022
Clinical Pharmacy Technician Team Leader
Magellan Health Services
09.2014 - 09.2018
Ambulatory Pharmacy Technician
Henry Ford Health System
01.2014 - 04.2014
Insurance Verification Specialist
Walgreens Retail Pharmacy/Walgreens Specialty Pharmacy
07.2009 - 01.2014
Associate - Science/Radiology Technology
Schoolcraft College
Certified Pharmacy Technician -
Washtenaw Community College
Bachelor -
Eastern Michigan University