Kesley Resha
Greenbrier,TN
Summary
Experienced Certified Pharmacy Technician with over 15 years in the pharmacy industry and 2 years specializing in compliance-related roles. Passionate about maintaining regulatory standards, I bring a meticulous work ethic and a track record of implementing effective compliance policies and procedures. Recognized for my professionalism and ability to excel in dynamic environments, I am well-prepared to contribute to pharmacy operations while ensuring the highest standards of quality and compliance.
Overview
17
17
years of professional experience
1
1
Certification
Work History
Pharmacy Compliance Manager
RxPartners, LLC
09.2022 - Current
- Manage pharmacy policy and procedures to ensure adherence to ACHC standards in day-to-day pharmacy tasks
- Collects monthly data to adhere to Billing and Coding Errors Performance Indicators policy
- Assist with educating staff members regarding ACHC accreditation standards and the policies associated with meeting those standards
- Collect, track, and trend data related to complaints and errors per the Complaints and Errors Performance Indicator policy
- Maintain all policies and procedures related to pharmacy operations to ensure compliance with multiple state boards of pharmacies.
- Help establish departmental policies and procedures. Maintain knowledge of and responsible for current company policies and procedures as related to job description
- Conduct periodic investigations of staff accountability
- Stay current on all office automation in place or obtained by the company including, but not limited to, computers, electronic communication, and equipment and copiers
- Chair the Quality Management Committee
- Chair of the Safety Committee
- Responsible for performing tasks associated with the Patient Records and Accuracy Performance Indicator policy
- Work to ensure regulatory compliance based on the Regulatory Compliance Program policy
- Overall supervision of adherence to accreditation standards
- Maintains pharmacy license applications and renewals for four pharmacies for all 50 states.
- Streamline compliance processes by implementing efficient monitoring systems and tools.
Pharmacy Technician Supervisor
RxPartners, LLC
05.2022 - 09.2022
- Stocked shelves and removed out-of-date items from the inventory
- Mentored and trained team members.
- Helped with establishing and monitoring workflow production processes.
- Inputted patient data and prescription information into pharmacy information management system.
- Established and monitored team productivity metrics
- Labeled products appropriately, including cautionary or auxiliary labels.
- As permitted by applicable state laws, took verbal prescription orders from licensed prescribers and transferred prescriptions between dispensing pharmacies.
- Facilitated smooth communication between pharmacy staff and healthcare providers to resolve discrepancies or clarify prescription orders as needed.
- Maintained knowledge of and abided by applicable pharmacy laws and regulations.
Certified Pharmacy Technician
RxPartners
10.2020 - 05.2022
- Performed various pharmacy operational activities with a strong commitment to accuracy, efficiency, and service quality.
- Received and inputted prescription orders into a workflow.
- Worked with computerized and automated systems for dispensing medications and edited new patient profiles.
- Assisted with incoming calls from facilities, providers, and patients.
- Solved problems by telephone or email by providing assistance to facilities, patients, and coworkers.
- Assisted with adjudicating claims under part D benefits.
- Communicated with facilities to obtain clarification or more information on prescription orders and insurance coverage.
- Communicated with prescribers and facilities to obtain and process refill requests and patient information.
- Adhered to HIPAA regulations and upheld patient privacy rules.
Patient Care Advocate
Express Scripts/Cigna
04.2020 - 10.2020
- Educated members on services, insurance coverage, and payment liabilities.
- Handled high volume incoming calls from provider's offices, members, and third party representatives
- Educated members on the four stages of Medicare and deductibles.
- Provided drug cost information and determined the most cost-efficient source by performing test claims.
- Processed incoming member requests for mail-order prescriptions and renewals.
- Provided in-depth plan information including patient deductibles, out-of-pocket maximums, and prescription drug coverage.
Intake Care Senior Representative
Cigna-HealthSpring
01.2014 - 04.2020
- Processed medication prior authorization requests from provider's via fax,phone, and electronic submissions.
- Performed monthly quality tests to ensure clinical edits were flowing correctly in Medhok.
- Reviewed and updated Medicare dual enrolled members eligibility flags.
- Worked alongside pharmacists to update annual policy and procedures for coverage determination processes and lock-in program processes.
- Audited and submitted date from monthly controlled substances reports to support the Texas Medicaid lock in program sponsored by the Texas Office of Inspector General.
- Reviewed and submitted inquiries and audits requested by the OIG to support data submitted for pharmacy lock in members.
- Acted as a subject matter expert during Medicare trainee onboarding classes.
- Handled email inquiries to support other departments.
Claims Resolution Specialist
Tri-Med Pharmacy
01.2009 - 01.2014
HealthSpringRxPartners
- Processed and resolved daily pharmacy claim rejections.
- Acted as a liaison to nursing facility directors to support obtaining medication coverage.
- Handled outbound calls and faxed coverage determination requests to insurance providers to obtain part D prior authorizations.
- Started coverage determination requests through covermymeds.com on behalf of providers and nursing facilities.
- Assisted with monthly billing adjudications and resolved outstanding claim rejections.
- Maintained records of all prior authorizations to prevent lapse in coverages.
Pharmacy Technician
Tri-Med Pharmacy, LLC
12.2007 - 01.2009
- Unloaded daily shipments and put away new stock.
- Avoided product waste with proper stock rotation procedures.
- Labeled and filled daily prescriptions.
- Prepared sterile compounds and IVs.
- Packaged blister pack cards for assisted living facilities.
- Met daily delivery deadlines for long care facility shipments
- Participated in quarterly audits for controlled and non-controlled medications
- Assisted with daily medication purchases to replenish used stock.
- Compared pricing through Cardinal and McKesson for inventory control.
- Inspected drug storage sites to monitor drug supply expiration and maintain proper supply levels.
- Cleaned equipment and work areas and sterilized glassware to maintain safe and sanitary conditions.
- Minimized risk and maintained accuracy, adhering to proper medication-handling techniques and industry best practices.
Marketing Assistant
Standard Candy Company
01.2007 - 12.2007
- Prepared online order requests for baskets, sample requests, etc.
- Maintained Excel sheets for daily data from sales and sample requests.
- Attended trade shows and events to market products.
- Assisted the marketing director with daily tasks.
- Assisted the receptionist with coverage during rest and break periods.
Education
Associate of Science - Business Management
Volunteer State Community College
Gallatin, TN12.2021
Skills
- Pharmacy Operations
- Problem-Solving
- Verbal and Written Communication
- Microsoft Office
- CMS and HIPAA guidelines
- Compliance documentation
- Internal Auditing
- Document reviews
Certification
- Certified by the Pharmacy Technician Certification Board (PTCB)
- Registered Pharmacy Technician
- Certificate for Essential Elements of Compounded Sterile Preparations
Timeline
Pharmacy Compliance Manager
RxPartners, LLC
09.2022 - Current
Pharmacy Technician Supervisor
RxPartners, LLC
05.2022 - 09.2022
Certified Pharmacy Technician
RxPartners
10.2020 - 05.2022
Patient Care Advocate
Express Scripts/Cigna
04.2020 - 10.2020
Intake Care Senior Representative
Cigna-HealthSpring
01.2014 - 04.2020
Claims Resolution Specialist
Tri-Med Pharmacy
01.2009 - 01.2014
Pharmacy Technician
Tri-Med Pharmacy, LLC
12.2007 - 01.2009
Marketing Assistant
Standard Candy Company
01.2007 - 12.2007
Associate of Science - Business Management
Volunteer State Community College
Similar Profiles
Zarrina KhawajaZarrina Khawaja
Overnight Pharmacist/remote clinical pharmacist/retail &independent pharmacy at Payless Staffing LLC /Tact Staffing LLC & Medical Staffing LLCOvernight Pharmacist/remote clinical pharmacist/retail &independent pharmacy at Payless Staffing LLC /Tact Staffing LLC & Medical Staffing LLC
Ida BeachyIda Beachy
Office Manager/Head Bookkeeper at Sunnybrook Excavating LLC, RHL Logistics LLC, Denny's Trucking LLCOffice Manager/Head Bookkeeper at Sunnybrook Excavating LLC, RHL Logistics LLC, Denny's Trucking LLC
Kimberlie PriserKimberlie Priser
Senior Loan Processor at Acrisure Mortgage, LLC Fka FBC Mortgage, LLCSenior Loan Processor at Acrisure Mortgage, LLC Fka FBC Mortgage, LLC
Jordyn GoodwinJordyn Goodwin
House Mover at College Hunks Hauling Junk & MovingHouse Mover at College Hunks Hauling Junk & Moving
JOHN BLACKABYJOHN BLACKABY
Software Engineer at CGISoftware Engineer at CGI