Jolynn Salazar

• Conducts quality audits of casework to ensure accuracy, compliance, and adherence to established policies and procedures; provided coaching and constructive feedback to support performance improvement.
• Reviewed Prime's High Dollar Reports for accuracy, identified missing authorizations, and completed authorization entries to ensure timely and accurate case processing.
• Serve as a subject matter resource for technicians, clinic staff, and Member Services representatives by providing guidance on case-related issues, Medicaid processes, and operational procedures.
• Respond to completed requests by creating written communication of the clinical outcome to the member and the member's physician within client specific turnaround times
• Manage work queue and volumes to meet client specific turnaround times

Review criteria to determine if the request can be approved

• Currently assists newly trained technicians with cases and answers any questions they have.
• I worked with a small team to create a PowerPoint presentation and presented quantity limit scenarios to team huddles.
• Assisted with Integrity checks and First level appeal checks

• Review criteria to determine if the request can be approved
• Accurately enter Prior Authorization in claims system to ensure appropriate claims will adjudicate
• Respond to completed requests by creating written communication of the clinical outcome to the member and the member's physician within client specific turnaround times
• Perform outreach to pharmacies and physician's offices related to the department process across multiple clients to obtain all necessary information related to UM requests, including occasional member assistance
• Provide all relevant clinical information specific to a UM request to a department Pharmacist and the Physician
• Manage work queue and volumes to meet client specific turnaround times
• Currently a learning coach assisting newly trained technicians with clinical review questions

• Enter members profile information and prescriptions fast and accurately, while continuing to meet Prime's hourly and quality rates
• Handle incoming and outgoing calls from doctor's offices and made calls to members to inform them the status of their orders as well as resolve issues
• Assist Pharmacists to fill prescriptions in a production environment
• Provide training in doctor call queue, exceptions queue, CII queue, member call queue, and various other queues within Prime
• Effectively resolved insurance rejections and other billing issues
• Completed a Brand to Generic pilot project to help members and Prime manage the cost of medications.
• Worked as part of the C2 team. Responsible for maintaining a detailed log of all C2 prescriptions received, provided outreach to doctors and member regarding C2 medications issues, concerns and to set up shipping.

• Retail setting
• Fast and efficiently filled prescriptions.
• Assisted with inventory. Stocked medications, rotated inventory and routinely checked for expired medications.
• Hand counted controlled medications, measured liquid and reconstituted medications.
• Managed inventory
• Receptively provided excellent customer service to customers attempting to obtain prescriptions or a desired item in the pharmacy and store.

• Complied with all federal laws, company policies, procedures and state regulations regarding intern technician and assistant training and licensure.
• Entered Prior Authorizations received while ensuring they were routed correctly to the system corresponding with the members insurance or medication being requested.