Grethel Castelvi
Miami,USA
Summary
Proactive and goal-oriented professional with excellent time management and problem-solving skills. Known for reliability and adaptability, with swift capacity to learn and apply new skills. Committed to leveraging these qualities to drive team success and contribute to organizational growth.
Overview
16
16
years of professional experience
1
1
Certification
Work History
Pharmacy Prior Authorization Specialist
Jackson Pharmacy Solutions
08.2016 - Current
- Discuss medications, insurance, and prior authorization documents with patients
- Appeal insurance companies after prior authorization refusals
- Follow up on missing or incorrect information so patients receive the right reimbursement
- Document accounting activity using correct medical and billing codes
- Assess accounts for completeness and accuracy
Pharmacy Technician
CVS Pharmacy
07.2008 - 07.2016
- Accurately and efficiently prepare prescription orders
- Entering patients and ordering information into the pharmacy system
- Processing and submitting insurance claims
- Providing quality customer service to patients and other healthcare providers
- Maintaining pharmacy inventory by checking pharmaceutical stocks to determine inventory level, anticipating needed medications and supplies, placing, and expediting orders, verifying receipt, removing outdated drugs
- Organizing medication for pharmacists to dispense by reading medication orders and prescription, preparing labels
Education
Master of Business Administration - Healthcare
Florida International University
Miami, FL01.2023
Bachelor of Science - Psychology
Carlos Albizu University
Miami, FL01.2020
Associate degree - Science
Miami Dade Community College
Miami, FL01.2008
Skills
- Lean Six Sigma Green Belt
- Healthcare Market
- Pharmaceutical Terminology
- MS Office
- Organization
- Integrity
- Prior Authorization Process
- ICD-10 Coding Familiarity
- Medical Appeals Handling
- Effective communication skills
- Data Entry
- Medicare and Medicaid knowledge
- Insurance Verification
Degrees
- H-MBA
- BS
- CPhT
Certification
- Six Sigma Certification
Languages
Spanish
Full Professional
Timeline
Pharmacy Prior Authorization Specialist
Jackson Pharmacy Solutions
08.2016 - Current
Pharmacy Technician
CVS Pharmacy
07.2008 - 07.2016
Bachelor of Science - Psychology
Carlos Albizu University
Associate degree - Science
Miami Dade Community College
- Six Sigma Certification
Master of Business Administration - Healthcare
Florida International University
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