Kiana Torres
Tampa,FL
Summary
I am a highly motivated and compassionate Healthcare Associate with over 10 years of experience in healthcare administration. My commitment to delivering exceptional patient experiences is evident in my expertise in Pharmaceutical Management, including Retail, Specialty, Fertility, Compounding, Claim processing, Authorization Processing, CRM systems, and Account receivable. I am eager to contribute my skills and experience to a well-established company that values loyalty, responsibility, adaptability, and dedication in its team members.
Knowledgeable Registered Pharmacy technician with thorough understanding of patient care coordination and support. Successfully facilitated comprehensive care plans, ensuring seamless communication between healthcare providers and patients. Demonstrated ability to manage complex caseloads and use problem-solving skills to improve patient outcomes.
Overview
9
9
years of professional experience
1
1
Certification
Work History
Lead Care Coordinator, Claim Processor, Account Receivable
South Miami Pharmacy
03.2021 - Current
- Lead Care Coordinator
- Ensuring seamless communication between patients, healthcare providers, and technician.
- Leading and supervising a team of care coordinators and healthcare providers.
- Addressing any issues or obstacles that may arise during patient care.
- Reporting to higher-level management and participating in regular meetings to discuss patient care outcomes and improvements.
- Monitoring and improving the quality of care provided, adhering to regulatory standards.
- Managing resources like medical equipment, personnel, and budget for effective patient care.
- Maintaining accurate patient records and documenting care plans and outcomes.
- Staying updated on healthcare trends and best practices to improve patient care.
- Claim Processor
- Reviewing and processing insurance claims submitted by patients and healthcare providers for fertility-related treatments and procedures.
- Verification: Verifying the accuracy and completeness of claim submissions, including medical codes, documentation, and patient information.
- Eligibility Assessment: Determining whether patients have valid insurance coverage for fertility treatments, including in vitro fertilization (IVF), diagnostic testing, and other related services.
- Documentation Review: Analyzing medical records, invoices, and other supporting documents to assess the necessity and appropriateness of the claimed procedures.
- Adjudication: Adjudicating claims by applying insurance policies, guidelines, and regulations to determine the coverage and reimbursement amounts.
- Communication: Corresponding with healthcare providers, patients, and insurance companies to clarify claim details, request additional information, and provide claim status updates.
- Payment Processing: Calculating and processing claim payments in accordance with insurance policies and contractual agreements.
- Denial Management: Handling claim denials by investigating reasons for denial, working with providers to address issues, and appealing denials when necessary.
- Compliance: Ensuring compliance with healthcare regulations and privacy laws (e.g., HIPAA) when handling sensitive medical and financial information.
- Assisting and supporting patients and healthcare providers regarding claim inquiries, coverage questions, and reimbursement issues.
- Data Entry and Reporting: Accurately entering claim information into the system and generating reports to track claim processing metrics and trends.
- Account Receivable
- Prepare and issue invoices to customers accurately and in a timely manner.
- Payment Processing: Record and track customer payments, ensuring they are applied correctly to outstanding invoices.
- Collections: Monitor overdue accounts and contact customers for payment follow-up, resolve billing issues, and negotiate payment arrangements when necessary.
- Reconcile accounts receivable records with general ledger to ensure accuracy.
- Generate reports detailing accounts receivable status, aging analysis, and cash flow projections.
- Maintain professional and effective communication with customers to address inquiries and resolve disputes.
- Documentation: Maintain organized and up-to-date records of all accounts receivable transactions and correspondence.
- Credit Analysis: Assess creditworthiness of new and existing customers, establish credit limits, and recommend credit terms.
- Cash Application: Ensure proper allocation of payments to customer accounts and resolve discrepancies.
- Account Maintenance: Maintain customer accounts, update contact information, and address changes in billing terms.
- Used company software and databases to maintain records of services performed and patient conditions.
- Managed patient caseloads effectively, ensuring timely follow-up and appropriate interventions.
- Developed strong relationships with community partners, facilitating referrals and collaboration on behalf of patients.
- Conducted regular evaluations of care plan effectiveness, making necessary adjustments based on feedback from patients and providers.
- Built strong relationships with clients to deliver emotional support and companionship.
- Streamlined patient intake processes, reducing wait times and improving patient satisfaction.
- Implemented successful healthcare program through professionalism, quality of care, medical teaching and patient satisfaction.
- Trained pharmacy interns and newly hired pharmacy technicians.
Progyny Care Coordinator
South Miami Pharmacy
03.2021 - 01.2022
- Manage Progyny members' cycles following Waste Management guidelines for initial and refill orders and management protocols.
- Act as liaison between Progyny RX members and Progyny PBS team for any number of reasons including, but not limited to, authorizations, medical exceptions, medical reasoning etc...
- Assess members needs and document all communication in the Electronic Medical Records system regarding coordination of cycle and medications.
- Adhere to call center scripts, guidelines, and standards to ensure consistent service quality and compliance with company policies.
- Assist with incoming calls in a high- volume call center, addressing provider and member questions and/or concerns while working within given performance guarantees.
- Conduct outbound calls for various purposes, including follow-ups, surveys, and appointment scheduling.
- Scheduling deliveries of extremely time-sensitive medications and managing the refilling of medications throughout a member Fertility cycles (IVF and FET)
- Benefit verification, insurance coverage and prior authorizations. Further, deciphering complex pricing for high-cost fertility medications, providing best pricing for patients
- Assisting with copay assistance, government subsidized programs and/or enrolling in manufacturer programs
- Document Intake: Reviewing incoming Scripts, faxed, Web-Portal and verbal and hard copy prescriptions for data entry using knowledge drawn from pharmacy technician experience.
- Information Dissemination: Offer accurate information about products, services, and company policies to customers and potential clients.
- Advocating for patients' needs within the healthcare system and helping them access necessary resources and support services.
Retail, Compound and Specialty Pharmacy Technician
South Miami Pharmacy
04.2017 - 02.2021
- Retail
- Medication Dispensing: Responsible for accurately measuring, counting, and dispensing prescription medications to patients. Ensure the correct dosage and medication are provided.
- Prescription Processing: Receive and interpret prescription orders from healthcare providers or patients, verifying their accuracy and legality. This may involve contacting prescribers for clarifications.
- Inventory Management: Monitor and maintain pharmacy inventory, ensuring that medications are in stock and arranging for restocking when necessary. They also check for expired or recalled medications.
- Customer Service: Assist patients by answering questions about medications, providing information on potential side effects, and offering advice on over-the-counter products.
- Labeling and Packaging: unit-dose packaging, label prescription containers with appropriate instructions and safety information.
- Recordkeeping: Maintain accurate records of prescription orders, transactions, and patient profiles. Compliance with privacy and confidentiality regulations is essential. Following federal and state regulations governing pharmacy practices, including controlled substance handling and record-keeping.
- Insurance Processing: Processing insurance claims, ensuring patients receive the maximum coverage for their medications.
- Compliance: Adhere to all relevant laws, regulations, and pharmacy policies, especially those related to patient privacy and controlled substances.
- Compounding
- Compounding: Assisting pharmacists in measuring, mixing, and preparing medications as per prescription or doctor's instructions.
- Quality Control: Ensure accuracy, potency, and purity of compounded medications.
- Recordkeeping: Maintain accurate records of prescription orders, transactions, and patient profiles. Compliance with privacy and confidentiality regulations.
- Equipment Maintenance: Maintain and clean compounding equipment. Preforming in control checks to ensure the accuracy and safety of dispensed medications.
- Inventory Management: Maintain stock of compounding ingredients and medications.
- Documentation: Keep detailed records of compounded medications and procedures.
- Customer Service: Assist patients with medication inquiries and providing instructions on proper medication use.
- Compliance: Adhere to all relevant laws, regulations, and pharmacy policies, especially those related to patient privacy and controlled substances.
- Specialty
- Medication Dispensing: Accurately prepare, label, and dispense specialty medications, which often require specialized handling and storage.
- Patient Consultation: Interact with patients to provide information on medication usage, potential side effects, and proper storage, ensuring they understand their treatment regimen.
- Prescription Verification: Review and verify prescriptions, checking for accuracy and completeness, and ensuring compliance with legal and regulatory requirements.
- Insurance Coordination: Work with insurance companies to obtain prior authorizations and verify coverage for specialty medications, helping patients navigate the reimbursement process.
- Inventory Management: Monitor and maintain inventory of specialty medications, ensuring adequate stock levels and appropriate storage conditions.
- Compounding Assistance: Prepare specialized medication formulations as prescribed by healthcare providers, adhering to safety and quality standards.
- Documentation: Maintain accurate and confidential records of medication dispensing, patient interactions, claims and insurance-related information.
- Collaborate with healthcare providers, nurses, and other healthcare professionals to ensure coordinated care and address patient needs.
- Adherence Support: Assist patients in adhering to their medication regimens through medication synchronization, refill reminders, and counseling.
- Quality Assurance: Perform quality control checks to ensure the accuracy and safety of dispensed medications.
Pharmacy Technician
Walgreens
02.2017 - 04.2017
- Supported Pharmacist by stocking, assembling, and distributing medications.
- Maintained High quality customer service by greeting patients and health care providers.
- Answering phones, questions and requests, and referring inquiries to the pharmacist.
- Maintained pharmacy inventory by checking pharmaceutical stock to determine inventory level, anticipating needed.
- Medications and supplies and expediting orders, verifying receipt, and removing outdated drugs.
- Maintains a safe and clean pharmacy by complying with procedures, rules, and regulations.
- Protects patients and employees by adhering to infection-control policies and protocols.
- Organized medications for pharmacist to dispense by reading medication orders and prescriptions, preparing labels, calculating quantities, and assembling intravenous solutions and other pharmaceutical therapies.
- Maintained records by recording and filing physicians' orders and prescriptions.
- Generated revenues by calculating, recording, and issuing charges.
- Ensures medication availability by delivering medications to patients and departments.
- Prepare reports by collecting and summarizing information.
- Contributed to team effort by accomplishing related results as needed.
Education
Registered Pharmacy Technician - undefined
NPI Technical School
Miami Beach, FL01.2017
High School -
Coral Park senior high school
Miami, Florida05.2013
Skills
- Case management
- Documentation
- Patient education
- Organizational skills
- Medical terminology understanding
- Documentation proficiency
- Patient advocacy
- Claims processing
- Quality assurance
- Scheduling
- Insurance practices
- HIPAA compliance
- Data entry
- Workflow management
- Critical thinking
Accomplishments
- Collaborated with team of 10 in the development of Data entry workflow.
- Supervised team of 50 staff members.
- Documented and resolved Patient complaints which led to retracting statements
Certification
- Licensed Registered Pharmacy Technician - since 2017
Languages
English
Native or Bilingual
Spanish
Native or Bilingual
Timeline
Lead Care Coordinator, Claim Processor, Account Receivable
South Miami Pharmacy
03.2021 - Current
Progyny Care Coordinator
South Miami Pharmacy
03.2021 - 01.2022
Retail, Compound and Specialty Pharmacy Technician
South Miami Pharmacy
04.2017 - 02.2021
Pharmacy Technician
Walgreens
02.2017 - 04.2017
Registered Pharmacy Technician - undefined
NPI Technical School
High School -
Coral Park senior high school
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