Kayla Crosby
Kuna,ID
Summary
Hardworking and passionate job seeker with proven track record of excellent customer service and consistent results. Possesses excellent communication skills, professional attitude and keen attention to detail.
Overview
11
11
years of professional experience
Work History
Pharmacy Specialist
Blue Cross Of Idaho
10.2023 - Current
- Setting up, reviewing, researching, documenting and recommending correct administrative action of pharmacy benefit inquiries.
- Working closely with Pharmacy Manager to develop and maintain interdepartmental workflow procedures.
- Review various claims in a timely manner and request prior authorization for prescription drugs.
- Using clinical judgement and appropriate review criteria to place overrides as needed in the system.
- Used Facets, Jiva, and CCA programs
Certified Pharmacy Technician
Fred Meyer Pharmacy
03.2023 - Current
- Answered incoming phone calls and addressed questions from customers and healthcare providers.
- Completed paperwork, entering prescription and insurance or billing information into patient profiles.
- Solved customer problems in-person or over telephone by providing assistance with placing orders, navigating systems, and locating items.
- Consulted with insurance company representatives to complete claims processing, resolve concerns, and reconcile payments.
- Reviewed and verified customer information and insurance provider information.
- Helped pharmacist clear problematic prescriptions and address customer questions to keep pharmacy efficient.
- Interpreted and processed medication orders under supervision of pharmacist.
- Leveraged database to confirm validity of prescriptions, patient data and drug side effects.
- Refilled medications, offered insight into over-the-counter products and verified insurance benefits.
- Prepared prescription transfers to other pharmacies.
- Inspected medication storage locations to monitor drug expiration dates and supply adequate inventory.
- Flagged potential side effects and allergies to prescribed medications for patients.
- Received written prescriptions or refill requests, verifying information for completeness and accuracy.
- Created new customer profiles and updated demographics, allergies and new medication in pharmacy computer systems.
- Verified prescription and drug labels, documents and packages.
Certified Pharmacy Technician-Prior Authorization
CVS Pharmacy
03.2022 - 03.2023
- Reviewing Prior Authorization Guidelines of prescription medications.
- Conducts research to facilitate problem resolution of pharmacy claims/benefits.
- Notified ordering providers of denied authorizations.
- Applied knowledge of Medicare, Medicaid and third- party payer requirements with insurance providers.
- Followed all Medicare, Medicaid, HIPAA, and private insurance regulations and requirements.
- Determined which party would be liable for payment on medical services by thoroughly reviewing patient insurance coverage.
- Performed detailed medical reviews of prior authorization request, following established criteria and protocols.
- Scheduled peer to peer reviews for physicians to discuss medical necessity with insurance providers.
- Gathered all necessary information from the Doctor's office to complete the authorization form.
Certified Pharmacy Technician-Central Processing
Albertsons Pharmacy
02.2021 - 02.2023
- Entered and processed patients' prescriptions into internal system.
- Set up and modified patient profiles to include current medications and insurance details.
- Helped pharmacist clear problematic prescriptions.
- Verified documentation methodically to avoid critical errors.
- Teamed with peers, technicians and pharmacists to prioritize and complete orders.
- Established or maintained medications and other patient profiles.
- Assisted pharmacists with clearing high volume of prescriptions and responded to customer questions.
Certified Pharmacy Technician
Medicap Pharmacy
07.2020 - 02.2021
- Performed wide range of pharmacy operations with strong commitment to accuracy, efficiency and service quality.
- Counted and labeled prescriptions with correct item and quantity.
- Assisted pharmacist by filling prescriptions for customers and responding to patient questions.
- Maintained proper drug storage procedures, registries, and records for controlled drugs.
- Collected payments from customers.
- Restocked pharmacy shelves with current merchandise.
- Answered incoming phone calls and addressed questions from customers and healthcare providers.
Certified Pharmacy Technician
Jack's Pharmacy
08.2019 - 06.2020
- Dispensing medication to patients per the prescription, or provider's orders.
- Packing and labeling prescribed medication.
- Processing insurance claims.
- Processing prescriptions electronically and ensuring all information is complete and accurate.
- Answered incoming phone calls and addressed questions from customers and healthcare providers.
- Stocked, labeled, and inventoried medication to keep accurate records.
- Restocked pharmacy shelves.
- Managed opening and closing duties for pharmacy.
Certified Pharmacy Technician
Irwin Drug Pharmacy
12.2012 - 08.2019
- Perform calculations
- Process third party billing claims and assist with prior authorization completion
- Answered incoming phone calls and addressed questions from customers.
- Reviewed and verified customer information and insurance provider information.
- Communicated directly with doctors offices via telephone, fax and email.
- Filled prescriptions, and prepared prescription labels with accuracy.
- Performed various pharmacy operational activities with strong commitment to accuracy, efficiency, and service quality.
- Communicated with patients to collect information about prescriptions and medical conditions or arrange consultations with pharmacists.
- Set up and modified patient profiles.
- Entered prescription information into computer databases.
- Operated cash registers to accept payments from customers.
Education
Nursing
Walla Walla Community College
Walla Walla, WANursing
Lewis Clark Sate College
Lewiston, IDHigh School Diploma -
Grangeville High
Grangeville, ID05.2008
Skills
- Microsoft office, word, excel, PowerPoint, one note
- Pharmacy computer programs
- Medical terminology
- Healthcare
- Customer service
- Sales
- Insurance billing, prior authorization
- Great teamwork
- Customer satisfaction
- Continuously improvement
- Weekly team meetings
- Problem solving
- Time management
- Answering calls
- Highly Driven
- Jabber and teams software
Timeline
Pharmacy Specialist
Blue Cross Of Idaho
10.2023 - Current
Certified Pharmacy Technician
Fred Meyer Pharmacy
03.2023 - Current
Certified Pharmacy Technician-Prior Authorization
CVS Pharmacy
03.2022 - 03.2023
Certified Pharmacy Technician-Central Processing
Albertsons Pharmacy
02.2021 - 02.2023
Certified Pharmacy Technician
Medicap Pharmacy
07.2020 - 02.2021
Certified Pharmacy Technician
Jack's Pharmacy
08.2019 - 06.2020
Certified Pharmacy Technician
Irwin Drug Pharmacy
12.2012 - 08.2019
Nursing
Walla Walla Community College
Nursing
Lewis Clark Sate College
High School Diploma -
Grangeville High
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