Joy Elkins
Gainesville
Summary
Dedicated team member with an in-depth knowledge of pharmacy prior authorization standards, compliance requirements, and operational procedures. Individual multitasker with excellent communication skills who is hardworking and eager to learn. Brings a unique compilation of knowledge regarding Prior Authorization Configuration, Pharmacy Benefit Management, and Medical Claims Review and Audit.
Overview
23
23
years of professional experience
Work History
Senior Coordinator, Business Configuration
CVS Health/Novologix
02.2022 - Current
- Process authorization protocols for pharmacy and medical drugs from Salesforce, ensuring accurate and timely intake for prior authorization workflows
- Load and manage authorization tickets in Helix system, facilitating seamless processing for program authorization
- Support processors in configuration authorizations within Novologix system, enabling provider and members to submit prior authorization requests efficiently
- Ensure accurate, up to date criteria are available for drug authorization requests, improving processing speed and reducing delays
Pharmacy Technician, Pharmacy Benefit Management | Auditor/Claims Reviewer, Claims Department
AvMed Health Plans
02.2002 - 02.2022
- Triaged and reviewed intake of prior authorization requests and entered for review based on coverage, formulary, and urgency
- Collaborated with internal departments regarding pharmacy related issues for member/providers
- Created letters based on coverage and contract language
- Daily/weekly reporting and logs created and managed
- Training of new hires and testing of new programs/procedures to improve workflow
- Performed daily reviews of medical claims processed by staff/system
- Lead auditor of focus audits (AT&T) and part of a team that executed larger accounts (State of Florida, Miami Dade County)
Education
Office Systems Specialist -Certificate - Insurance Processing
Santa Fe College
Gainesville, FL01.2003
Skills
- Microsoft Programs (Word, Excel, Outlook, Teams)
- Salesforce
- Novologix
- CVS/Caremark Client Portal
- Dane Street
- Reimbursementcodescom
Timeline
Senior Coordinator, Business Configuration
CVS Health/Novologix
02.2022 - Current
Pharmacy Technician, Pharmacy Benefit Management | Auditor/Claims Reviewer, Claims Department
AvMed Health Plans
02.2002 - 02.2022
Office Systems Specialist -Certificate - Insurance Processing
Santa Fe College
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