Foram Patel
Wesley Chapel
Summary
Detail-oriented Quality Assurance Auditor with a proven track record of developing and maintaining compliance programs. Known for diligence, organization, and proficiency in evaluation and audit procedures. Eager to apply skills in a new role to contribute to the growth of a dynamic operation.
Overview
7
7
years of professional experience
1
1
Certification
Work History
Pharmacy Technician-Quality Assurance
Centene
12.2023 - Current
- Performs audits related to the prior authorization and appeal process for all lines of business for Pharmacy Services; audits work completed by Pharmacy Technicians associated with verifying the accuracy of reviews and ensures compliance with quality standards, as well as promotes the organization's service standards. The Pharmacy Q.A audits to determine the integrity and accuracy of regulatory requirements at the Federal, State, and County level, as well as in compliance with departmental policies and procedures, providing statistical data and reports for various functional areas audited to identify continuous quality improvement opportunities.
- collect, analyze, and evaluate authorization and appeal request data; prepare comprehensive audit reports with findings and actionable recommendations for management.
- Develop and update auditing tools to ensure precise tracking and reporting of quality audit results.
- Identify trends in performance data and escalate issues related to policy interpretation and compliance.
- Recommend enhancements to systems, workflows, and documentation to optimize operational efficiency and effectiveness.
- Collaborate with cross-functional teams to improve internal procedures, ensuring alignment with regulatory requirements and service standards.
Pharmacy Technician
Centene
10.2022 - 12.2023
- Engages in drug utilization review (DUR) by supporting the execution of DUR program outreach to members/providers. Supports basic data analytic activities and tracking of interventions, and assists with preparation and documentation of responses to regulatory audits associated with the over utilization program.
- Provides medication therapy management (MTM) services via triage of inbound calls to the MTM hotline, monitors fax line for prescriber responses and completion of failed faxes, supports the pharmacist for completion of Comprehensive Medication Reviews (CMRS) through pre-work up and case preparation, communicates with network pharmacies, prescribers, and beneficiaries to provide MTM services.
Prior Authorization Pharmacy Technician
CareSource
05.2022 - 09.2022
- Engages in quality improvement projects including supporting the execution of prescriber mailings and tracking and maintaining physician and member responses regarding pharmacy quality outreach campaigns.
- Documents and records services/activities in appropriate databases/software to ensure compliance with CMS requirements for clinical service offerings assigned in designated area (i.e. MTM services, Quality Improvement Projects, DUR, etc.).
- Serve as backup for technicians in the other clinical service departments (Drug Utilization Review, Medication Therapy Management, Quality Improvement).
- Followed all Medicare, Med acid HIPAA and private insurance regulations and requirement.
- Applied knowledge of Medicare, Medicaid and third-Party payer requirements utilizing on-line eligibility systems to verify patient coverage and policy limitation.
- Performed detailed medical reviews of prior authorization request, following established criteria and protocol.
- Used Express Script, Streamline, and MHK to input claim, find out patient current claims, prior authorization and other important medical data into system.
- The Pharmacy Technician's responsible for reviewing non formulary prior authorization request for CareSource providers and educating them resources outlining formulary alternative.
- Place prior authorization when a approval is appropriate in the CAS/Client access system.
- Document all telephone interaction in streamline.
- Assist case manager, member and provider service with pharmacy issue, and overrides.
- Initiate process for routing prior authorization requiring review by a pharmacist.
- Ensure all methods of inquires (facts, e-mail, ePA) and submission are answered with in the State mandated.
Pharmacy Technician
Tampa Specialty Pharmacy
06.2018 - 05.2022
- Interpret and enter prescription.
- Answers, resolves and triages inbound inquiries.
- Understanding of 3rd party insurances and follow-through of insurance-related issues.
- Resolves insurance related issues and assist's patients with various of financial assistance.
- Professional filling of prescriptions (right medication, right dosage, right amount).
- Communicate directly with patients over the phone to assist them in awareness of their medications.
- Assisted pharmacist with clearing high volume of prescriptions and responded to customer questions.
- Teamed with peers, technicians and pharmacists to prioritize and complete orders.
Education
Bachelor of Science - Health Informatics And Information Management
University of Central Florida
Orlando, FL12-2026
Associate of Arts -
Polk State College
Lakeland, FL12-2018
High School Diploma -
George Jenkins Senior High School
Lakeland, FloridaSkills
- Detail-Oriented
- Time Management
- Teamwork
- Leadership
- Compassionate & Empathetic
- Attention to detail
- Decision Making
- Problem solving
- Computer skills
- Office 365
- Tools RX 30
- Advanced RX
- POS system
- MS Office
- Express Script
- Streamline
Certification
- Pharmacy Technician
- HIPAA
- FWA
Accomplishments
- FBLA (Future Business Leadership Association) award at District level.
- Spanish Honor Award.
- Community Service Award.
Timeline
Pharmacy Technician-Quality Assurance
Centene
12.2023 - Current
Pharmacy Technician
Centene
10.2022 - 12.2023
Prior Authorization Pharmacy Technician
CareSource
05.2022 - 09.2022
Pharmacy Technician
Tampa Specialty Pharmacy
06.2018 - 05.2022
Bachelor of Science - Health Informatics And Information Management
University of Central Florida
Associate of Arts -
Polk State College
High School Diploma -
George Jenkins Senior High School
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