Jacqueline Casillas
Certified Pharmacy Technician
North Las Vegas,NV
Summary
Experienced Clinical Administrative Coordinator with 10 years experience as a Pharmacy Technician. Skilled in Prior Authorization case management, task delegation, and staff training. Excellent communication skills with background in team building and working with organizational leaders to establish business goals and growth.
Overview
9
9
years of professional experience
1
1
year of post-secondary education
Work History
Clinical Administrative Coordinator
UnitedHealth Group
Las Vegas, NV
09.2021 - Current
- Communicate with insurance company to complete prior authorization requests for government, commercial and medicaid plans.
- Investigated claims to check authorization status and to determine need for escalation.
- Coordinate, monitor and document updated patient care in CPR and Carelink Systems.
- Verified coverage benefits with insurance to determine which plan is liable for payment.
- Coordinate with Patient Navigator for a seamless flow in medication delivery.
- Utilize HCPC codes for drug, nursing and per diem billing and reimbursement.
- Composed and organized Prior Authorization documents for submission to government and commercial vendors using NitroPro editing program.
Sr Pharmacy Technician/Appeals Representative
OptumRx, UnitedHealth Group
Las Vegas, NV
11.2014 - 09.2021
- Mentored and guided peers as a Subject Matter Expert to help resolve processing issues and concerns.
- Facilitated trainings for the Prior Authorization and Appeals department resulting in highly trained personnel ready to act quickly in critical roles.
- Supported department leaders by managing work queue assisting in business forecasting.
- Set, enforced and maintained sense of urgency for timely responses in 4 email distribution lists requests from external vendors and departments.
- Oversaw department work queues and office operations during weekends on behalf of leadership.
- Answered incoming phone calls and addressed pre-determination questions from patients and healthcare providers.
- Positioned as the go-to person for up to 30 staff members to maintain responsiveness in business needs.
- Assisted in developing and implementing improvements to Prior Authorization System.
- Knowledgeable in Clinical Systems: PAS, AS400, RXHD, IDRS and Navigator.
Prior Authorization Pharmacy Technician
Adecco Staffing
Cypress, CA
06.2014 - 11.2014
- Inbound Call Center phone technician, resolved patient and provider issues by navigating systems and researching formularies/plans.
- Obtained and entered accurately patient demographics, provider credentials and drug information for Prior Authorization Review.
- Communicated with patients following HIPPA regulations when providing drug coverage update and arrange consultations with pharmacists.
- Performed outreach to prescribers to verify medication dosages and obtain clinical information following plan guidelines.
- Troubleshoot non-routine issues with external vendors in claim processing after Authorization in place.
Compounding Pharmacy Technician
Drug Depot Pharmacy
Santa Ana, CA
11.2012 - 06.2014
- Reviewed and submitted Compounding Prior Authorization requests for commercial, medicaid, medicare and worker compensation plans.
- Contacted insurances for claim processing issues and overrides.
- Calculated dosages, filled oral prescriptions, prepared deliveries and Rx labels with accuracy.
- Compounded topical creams, capsules, suspensions, lozenges, and suppositories while wearing personal protective equipment (PPE).
- Monitored Compounding Department inventory, checked in deliveries, track and remove expired medications, ensured proper drug storage and forecasted monthly stock levels.
- Oversaw and implemented new training procedures for new hires in Compounding Department.
- Supported pharmacists with Spanish speaking patients.
- Calibrated weight scales daily for record keeping and cleaned all equipment meeting standards.
Education
CA Board of Pharmacy #92251 Expires 12/31/2022 - Pharmacy Technician
American Career College
Anaheim, CA 09.2008 - 06.2009
CPhT #30120876 Expires 01/31/2024 - Pharmacy Technician Certification Board
American Career College
Anaheim, CA 12.2020 - 12.2020
Skills
Medicare, Medicaid, Commercial, Workers Compensation Plans
HCPC / ICD 10 Coding
Pharmacy Retail, Compounding, PBM
Quality Assurance and Inventory Management
CareLink, CPR, PAS, AS400 & Navigator experience
Confidentiality and HIPAA
Training implementation and Mentor for staff development
Pharmacy operations management
Timeline
Clinical Administrative Coordinator
UnitedHealth Group
09.2021 - Current
CPhT #30120876 Expires 01/31/2024 - Pharmacy Technician Certification Board
American Career College
12.2020 - 12.2020
Sr Pharmacy Technician/Appeals Representative
OptumRx, UnitedHealth Group
11.2014 - 09.2021
Prior Authorization Pharmacy Technician
Adecco Staffing
06.2014 - 11.2014
Compounding Pharmacy Technician
Drug Depot Pharmacy
11.2012 - 06.2014
CA Board of Pharmacy #92251 Expires 12/31/2022 - Pharmacy Technician
American Career College
09.2008 - 06.2009