JORGE L. GOMEZ JR.
Brooklyn
Summary
Experienced Certified Pharmacy Technician (CPhT) with over 10 years in PBM prior authorization, Medicare Part D, and both hospital and retail pharmacy settings. Skilled in coverage determinations, insurance resolution, and clinical documentation review. Communicates effectively with providers and members to ensure compliance and streamline prescription processing.
Overview
12
12
years of professional experience
1
1
Certification
Work History
Pharmacy Technician - Prior Authorization / PBM
Centene Corporation
09.2016 - 10.2025
- Tracked and processed prior authorization and coverage determination requests for Medicare Part D members, ensuring timely resolution and compliance
- Approved coverage determinations based on plan criteria, CMS guidelines, and internal policies
- Reviewed provider-submitted requests to assess necessity for pharmacist clinical review, facilitating appropriate patient care decisions
- Obtained verbal authorizations and requested detailed clinical documentation from prescribers
- Entered and documented authorization decisions in PBM systems, ensuring accuracy and audit readiness
- Notified providers, physicians, and members of authorization decisions, maintaining regulatory turnaround times and enhancing communication
- Responded to provider and client inquiries regarding authorization status and PBM online platforms
- Referred specialty medication requests to delegated vendors or client teams for processing
- Maintained strict adherence to HIPAA, CMS, and compliance standards
Pharmacy Technician - Hospital Inpatient
Physicians Regional Hospital - Pine Ridge
Naples
01.2016 - 05.2016
- Prepared and filled inpatient medication orders, ensuring accuracy and compliance with safety protocols under pharmacist supervision
- Collaborated with pharmacists and nursing staff to coordinate timely medication delivery, enhancing patient treatment efficiency
- Reviewed and resolved medication discrepancies
- Assisted with sterile and non-sterile compounding, including total parenteral nutrition (TPNs)
- Restocked and maintained Pyxis automated dispensing cabinets, optimizing medication availability for patient care
Pharmacy Technician - Retail
Walgreens Pharmacy
Naples
11.2013 - 05.2016
- Processed high-volume prescription orders with accuracy and efficiency
- Entered and verified prescriptions in pharmacy management systems to ensure accuracy and compliance
- Resolved insurance rejections for Medicare, Medicaid, VA, and commercial plans to facilitate patient access to medications
- Assisted with prior authorization requests and claim adjudication issues
- Educated patients on medication usage and refills, ensuring understanding of insurance coverage to promote adherence
- Maintained compliance with federal and state pharmacy regulations
Education
Pharmacy Technician Certification -
Heritage Institute
Fort Myers, FL10.2012
High School Diploma -
Palmetto Ridge High School
Naples, FL01.2009
Associate Degree Coursework -
Valencia State College
Orlando, FLGeneral Studies -
Florida Southwestern State College
Naples, FLSkills
- Prior authorization management
- Coverage determination processes
- Medicare Part D knowledge
- PBM system navigation
- Appeals support services
- Clinical documentation review
- Insurance resolution strategies
- Commercial insurance handling
- Medicaid and Medicare understanding
- VA benefits coordination
- HIPAA compliance standards
- CMS guideline adherence
- Pharmacy technician expertise
- Prescription entry accuracy
- SIG code interpretation proficiency
- Pyxis system operation
- Automated dispensing systems use
- Sterile compounding techniques
- Non-sterile compounding methods
- TPN preparation skills
- Discrepancy resolution tactics
- Microsoft Office proficiency
- Data entry accuracy
- Time management efficiency
- Provider outreach initiatives
- Member communication skills
Certification
- PTCB Certified Pharmacy Technician (CPhT), 10062368
- Florida Registered Pharmacy Technician, RPT54786
Personal Information
Title: CPhT
Languages
- English
- Spanish
Timeline
Pharmacy Technician - Prior Authorization / PBM
Centene Corporation
09.2016 - 10.2025
Pharmacy Technician - Hospital Inpatient
Physicians Regional Hospital - Pine Ridge
01.2016 - 05.2016
Pharmacy Technician - Retail
Walgreens Pharmacy
11.2013 - 05.2016
Pharmacy Technician Certification -
Heritage Institute
High School Diploma -
Palmetto Ridge High School
Associate Degree Coursework -
Valencia State College
General Studies -
Florida Southwestern State College