J Matthew Daugherty
Summary
Helpful professional commended as valuable team player with expertise in prescription benefits and customer service. Ready to bring 19 years of relevant work experience to new position.
Overview
19
19
years of professional experience
Work History
Prior Authorization Appeals Technician
CVS Caremark
Scottsdale, AZ
12.2016 - 05.2024
- Collaborated with physicians to obtain necessary clinical information for prior authorization submissions.
- Maintained thorough knowledge of insurance plan requirements, facilitating accurate and timely completion of authorization forms.
- Analyzed medical records and other documents to determine approval of requests for authorization.
- Reduced turnaround time for prior authorization requests by utilizing electronic submission methods.
- Evaluated clinical criteria for approval or denial of services requiring pre-authorization.
- Monitored pending cases closely, proactively following up on outstanding documentation needed for successful approval outcomes.
- Provided training to new staff members on the intricacies of various insurance plans and their specific prior authorization requirements.
- Organized work to meet demanding production goals.
- Completed job reports and logs immediately following authorization calls.
Customer Service Advocate
OptumRx
Phoenix, AZ
01.2013 - 12.2016
- Peer & manager support post-merger for software implementation
- New-hire workflow & process mentoring
- Insurance plan benefits validation & explanation for external & internal inquiries
- Claim adjudication correction
- Provided input for new-hire training material
- Continued multi-systems use to support pharmacy processing.
- Managed high call volume during peak hours, prioritizing urgent cases while maintaining attention to detail.
- Improved team performance by providing constructive feedback, guidance, and encouragement to fellow Customer Service Representatives.
- Handled escalated calls professionally while working towards amicable resolutions that satisfied both parties involved.
Contract Assignments
Apple One
Phoenix, AZ
01.2011 - 01.2012
- Large scale file conversion and data structure creation project for Federal Government contract
- Order processing
- Web navigation assistance.
Account Manager
CVS Caremark
Scottsdale, AZ
01.2009 - 01.2010
- Managed the resolution of client requests for the BCBS Federal Employee Program prescription insurance
- Used proprietary internal systems & processes to provide insurance benefit issue resolution & workaround changes
- Communicated with internal and external partners to meet contractual obligations and timely resolution of requests
- Demonstrated a high level of quality client service through with accuracy, responsiveness, reliability and professionalism on every interaction in a fast-paced environment; Responsible for identifying and documenting best practices.
- Presented regular updates on account performance to senior leadership, highlighting successes and areas requiring attention.
- Fostered an environment of collaboration and open communication with internal teams to ensure seamless execution of national account initiatives.
Blues Team Resolution Representative
CVS Caremark
Scottsdale, AZ
01.2005 - 01.2009
- Acted as team leader
- Closely worked with management & clinical staff for member appeals process quality assurance.
- Handled customer complaints quickly and professionally to restore customer confidence and prevent loss of business.
- Increased customer satisfaction by addressing and resolving complaints in a timely manner.
- Developed and maintained positive customer relations and coordinated with team members to properly handle requests and questions.
- Trained, oversaw, and mentored new team members to strengthen performance and job expertise.
- Resolved escalated issues when standard processes were not effective.
Skills
- Attention to Detail
- Customer Service
- Works Well Under Pressure
- Multitasking and Organization
- Benefit Coverage
- HIPAA Compliance
- Authorizations
- Prior Authorization Process
- Prescription Appeals Handling
Certifications Education
- Certified Pharmacy Technician, Pharmacy Technician Certification Board, 01/01/2008, present
- Business Associates in process, Scottsdale Community College, 01/01/2008, present, Scottsdale, AZ
Timeline
Prior Authorization Appeals Technician
CVS Caremark
12.2016 - 05.2024
Customer Service Advocate
OptumRx
01.2013 - 12.2016
Contract Assignments
Apple One
01.2011 - 01.2012
Account Manager
CVS Caremark
01.2009 - 01.2010
Blues Team Resolution Representative
CVS Caremark
01.2005 - 01.2009