Maeghan Jones

• Remained knowledgeable regarding company policies and procedures and current developments within operational departments.
• Submitted verbal and written notification to members and providers.
• Processed and finalized 50-100 appeals and grievances per day within agreed-upon turnaround time.
• Contributed to organizational goals by consistently meeting or exceeding established performance metrics related to appeals and grievances management.
• Upheld organization''s reputation as a compliant plan sponsor by staying current on all relevant regulations and guidelines governing the appeals and grievances process.
• Expedited resolution times by proactively communicating with members, providers, and other stakeholders throughout the grievance process.
• Demonstrated high-level attention to detail when reviewing medical records, provider contracts, and other relevant documents during case assessments.
• Demonstrated optimal utilization of multiple pharmacy applications such as PA Hub, MedAppeals, Citrix, HealthRules Payer, OnBase, and Salesforce, etc
• Provided exceptional customer service when interacting with individuals involved in each appeal or grievance situation, demonstrating empathy and professionalism at all times.

• Managed sensitive patient information with strict adherence to HIPAA guidelines, maintaining confidentiality and privacy at all times.
• Verified eligibility and compliance with authorization requirements for service providers.
• Optimized turnaround times for prior authorization requests, collaborating closely with physicians and clinical staff to expedite necessary treatments.
• Exhibited strong attention to detail when evaluating eligibility criteria for medication coverage, minimizing instances of inappropriate denials or delays in treatment access.
• Streamlined communication between patients and healthcare providers, ensuring timely responses to inquiries and concerns.
• Communicated with insurance companies to verify coverage and obtain authorizations for medical treatments and procedures.
• Improved patient satisfaction by efficiently managing prior authorization requests and ensuring timely approvals.
• Reduced errors in documentation by meticulously reviewing medical records and verifying patient information.

• Facilitated communication and collaboration among staff and other specialty units regarding issues related to patient care and medications
• Facilitated the patient admission process including collection of patient information and financial data
• Performed clerical tasks such as answering phone calls and questions pertaining to prescriptions, insurance, patient data, etc
• Maintained files and patient information up to date
• Scheduled and coordinate lab appointments with patients and caregivers for Schizophrenia patients to obtain levels before dispensing medication
• Processed all order change forms including medication discontinuations and medication and dosage changes
• Processed insurance rejections pertaining to Prior Authorizations, DUR codes, etc
• Handled customer accommodations independently with good judgment and involving a Supervisor/Manager when necessary

• Managed multiple priorities effectively while working in a fast-paced hospital environment during high-volume periods.
• Developed strong relationships with fellow healthcare professionals, fostering an atmosphere of collaboration and teamwork to achieve common goals.
• Supported the training of new pharmacy technicians to enhance team performance and improve workflow efficiency.
• Ensured compliance with regulatory standards by adhering to protocols for controlled substances management.
• Increased patient safety through proper labeling, packaging, and storage of medications.
• Developed strong relationships with local community partners including physicians'' offices, nursing homes, and other facilities to facilitate seamless transitions of care.
• Ensured regulatory compliance by adhering to established guidelines for medication reconciliation procedures and documentation.
• Enhanced medication management for patients by diligently updating electronic medical records with accurate information.

• Enhanced pharmacy workflow by assisting pharmacists with medication dispensing, labeling, and packaging.
• Calculated dosage, filled prescriptions, and prepared prescription labels with absolute accuracy.
• Promoted patient confidentiality by adhering to HIPAA regulations when handling personal information during transactions.
• Assisted in maintaining a clean and organized work environment, ensuring compliance with safety regulations.
• Increased overall pharmacy productivity by restocking supplies, organizing shelves, and maintaining cleanliness according to standards.
• Assisted in maintaining Joint Commission accreditation standards through strict adherence to established policies and procedures regarding IV medication preparation and dispensing.
• Ensured proper disposal of hazardous waste materials following institutional policies and procedures to maintain a safe working environment for employees.
• Reduced medication errors with diligent attention to detail when calculating dosages and measuring ingredients.

• Supervised pharmacy technicians and coordinated day-to-day assignments.
• Helped maintain a clean and organized workspace for optimal efficiency during high-volume periods.
• Answered incoming phone calls and addressed questions from customers and healthcare providers.
• Promoted teamwork among pharmacy staff, fostering a collaborative environment for improved productivity.
• Resolved non-routine issues like third-party billing, computer system, and customer service issues.
• Stocked, labeled, and inventoried medication to keep accurate records.
• Maintained and updated patient records, prescription information and patient data in accordance with HIPAA regulations.
• Supervised junior technicians, providing guidance on best practices in pharmaceutical processes and procedures.

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• Answered incoming phone calls and addressed questions from customers and healthcare providers.
• Utilized advanced computer systems for prescription processing tasks such as inputting orders, updating patient profiles, and generating labels accurately.
• Demonstrated strong attention to detail when preparing customized compound medications per pharmacist instructions meeting the unique needs of individual patients.
• Effectively managed high-pressure situations by prioritizing tasks focusing on time-sensitive needs.
• Communicated with insurance companies resolving billing issues promoting seamless coverage for customers.
• Counted and labeled prescriptions with correct item and quantity.
• Entered and processed patients' prescriptions into internal system.
• Communicated with patients to collect information about prescriptions and medical conditions or arrange consultations with pharmacists.
• Maintained proper drug storage procedures, registries, and records for controlled drugs.