Krista M. Nelson
Aurora,Co.
Summary
Demonstrates strong analytical, communication, and teamwork skills, with proven ability to quickly adapt to new environments. Eager to contribute to team success and further develop professional skills. Brings positive attitude and commitment to continuous learning and growth.
Overview
23
23
years of professional experience
Work History
Prior Authorization Specialist II
Elevance Health
07.2024 - Current
- Entering customer information into the system
- Analyzing patient chart notes and labs for completeness
- Deciding who contractually needs to be contacted for the prior authorization for specialty medications
- Submit prior authorization paperwork either to the physician to send to the insurance or submit paperwork to the insurance to get the authorization for payment of prescribed medication
- Request further information if needed from the physician either by fax or phone call directly or through the inside sales representative
- Solve any errors in regards to prior authorization requests
- Process prescriptions as needed once the request has been approved.
- Verified eligibility and compliance with authorization requirements for service providers.
- Input all patient data regarding claims and prior authorizations into system accurately.
- Evaluated clinical criteria for approval or denial of services requiring pre-authorization.
- Responded to inquiries from healthcare providers regarding prior authorization requests.
- Analyzed medical records and other documents to determine approval of requests for authorization.
Certified Pharmacy Technician
Kaiser Permanente
12.2022 - 07.2024
- Traveling daily to assigned clinic
- Assisting in coming members with their new and refill prescriptions
- Enter prescriptions as they come up on the computer
- Solve insurance issues as needed
- Follow requests made by on-duty Pharmacists
- Return medications that have been in the holding area for longer than 10 days back to the shelf as a part of inventory control
- Answer the phones when assigned
- Fill prescriptions
- Fill the robot with medications as needed
- Ring up members
- Do opening and closing duties as assigned.
- Calculated dosage, filled prescriptions, and prepared prescription labels with absolute accuracy.
- Entered and processed patients' prescriptions into internal system.
- Stocked, labeled, and inventoried medication to keep accurate records.
- Collected co-payments or full payments from customers.
- Answered incoming phone calls and addressed questions from customers and healthcare providers.
- Performed various pharmacy operational activities with strong commitment to accuracy, efficiency, and service quality.
- Performed wide range of pharmacy operations with strong commitment to accuracy, efficiency and service quality.
- Welcomed customers to pharmacy and answered questions relating to prescriptions and over-the-counter products.
- Managed opening and closing duties for pharmacy.
- Set up and modified patient profiles to include current medications and insurance details.
- Ordered medicines daily to replenish stock and increase inventory in anticipation of need.
- Restocked pharmacy shelves with current merchandise to drive consistent peripheral sales.
- Maintained proper drug storage procedures, registries, and records for controlled drugs.
- Communicated with patients to collect information about prescriptions and medical conditions or arrange consultations with pharmacists.
- Consulted with insurance company representatives to complete claims processing, resolve concerns, and reconcile payments.
- Counted, measured, and compounded medications following standard procedures.
- Solved customer problems in-person or over telephone by providing assistance with placing orders, navigating systems, and locating items.
- Counted and labeled prescriptions with correct item and quantity.
- Monitored ordering of pharmacy medication stock to maintain streamlined inventory and low overhead.
- Resolved third-party billing, computer system and customer service issues.
- Helped pharmacist clear problematic prescriptions and address customer questions to keep pharmacy efficient.
Certified Pharmacy Technician
Walgreens
05.2021 - 12.2023
- Administering immunizations
- Entering incoming prescriptions, as well as faxed and e-scripts
- Stocked, labeled, and inventoried medication to keep accurate records.
- Ordered medicines daily to replenish stock and increase inventory in anticipation of need.
- Calculated dosage, filled prescriptions, and prepared prescription labels with absolute accuracy.
- Restocked pharmacy shelves with current merchandise to drive consistent peripheral sales.
- Communicated with patients to collect information about prescriptions and medical conditions or arrange consultations with pharmacists.
- Performed various pharmacy operational activities with strong commitment to accuracy, efficiency, and service quality.
- Answered incoming phone calls and addressed questions from customers and healthcare providers.
- Collected co-payments or full payments from customers.
- Performed wide range of pharmacy operations with strong commitment to accuracy, efficiency and service quality.
- Welcomed customers to pharmacy and answered questions relating to prescriptions and over-the-counter products.
- Managed opening and closing duties for pharmacy.
- Helped pharmacist clear problematic prescriptions and address customer questions to keep pharmacy efficient.
- Making sure that the drive through and walk in customers are helped promptly
- Answering telephones
- Helping the Pharmacist as needed
- Inventory control.
- Entered and processed patients' prescriptions into internal system.
- Maintained proper drug storage procedures, registries, and records for controlled drugs.
- Counted, measured, and compounded medications following standard procedures.
- Solved customer problems in-person or over telephone by providing assistance with placing orders, navigating systems, and locating items.
- Counted and labeled prescriptions with correct item and quantity.
- Set up and modified patient profiles to include current medications and insurance details.
- Precisely measured and combined ingredients to deliver scrupulous formulation on customer compound prescription orders.
- Monitored ordering of pharmacy medication stock to maintain streamlined inventory and low overhead.
Certified Pharmacy Technician
Swedish Medical Center
01.2008 - 01.2011
- Preparing intravenous solutions for patients throughout the hospital
- Training new employees on the everyday duties of the inpatient pharmacy
- Answering questions from nurses over the phone or in person
- Ensuring the proper and timely delivery of patient medications for daily distribution
- Assisting Pharmacists in answering phones and filling requests that they are receiving
- Provide internal and external customer service with nurses and fellow co-workers as well as vendors as needed
- Making sure that medications on the floors, clinics and in the pharmacy are in date as required by law.
Certified Pharmacy Technician
Rite Aid Pharmacy
10.2003 - 08.2008
- Traveling to different stores and filling in where help is needed throughout the state
- Training new employees in and out of state
- Scheduling other technicians and interns when other needs arise
- Intake and process incoming prescriptions from the phone and walk in customers
- Provide internal and external customer service with co-workers, insurance companies and vendors
- Preparing medication orders for nursing home patients to be delivered at specific pharmacies as well as outside billing for these facilities as needed.
- Calculated dosage, filled prescriptions, and prepared prescription labels with absolute accuracy.
- Entered and processed patients' prescriptions into internal system.
- 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.
- Collected co-payments or full payments from customers.
- Ordered medicines daily to replenish stock and increase inventory in anticipation of need.
- Answered incoming phone calls and addressed questions from customers and healthcare providers.
- Maintained proper drug storage procedures, registries, and records for controlled drugs.
- Performed various pharmacy operational activities with strong commitment to accuracy, efficiency, and service quality.
- Restocked pharmacy shelves with current merchandise to drive consistent peripheral sales.
- Communicated with patients to collect information about prescriptions and medical conditions or arrange consultations with pharmacists.
- Helped pharmacist clear problematic prescriptions and address customer questions to keep pharmacy efficient.
- Resolved third-party billing, computer system and customer service issues.
- Monitored ordering of pharmacy medication stock to maintain streamlined inventory and low overhead.
- Managed opening and closing duties for pharmacy.
- Set up and modified patient profiles to include current medications and insurance details.
- Stocked, labeled, and inventoried medication to keep accurate records.
- Counted, measured, and compounded medications following standard procedures.
- Counted and labeled prescriptions with correct item and quantity.
- Performed wide range of pharmacy operations with strong commitment to accuracy, efficiency and service quality.
- Welcomed customers to pharmacy and answered questions relating to prescriptions and over-the-counter products.
- Precisely measured and combined ingredients to deliver scrupulous formulation on customer compound prescription orders.
Certified Pharmacy Technician
Aurora Community Pharmacy
01.2003 - 12.2003
- Processing incoming prescriptions from walk in customers and the phone
- Internal and external customer service with physician offices, vendors and insurance companies
- Provide customer service through the ringing up of prescriptions and other products as needed
- Prepare and bill for once-a-month medications for in home nursing care.
Communications Technician
Action Care Ambulance
01.2002 - 01.2003
- Intake of emergent and non-emergent telephone calls
- Dispatching ambulances to these calls
- Deciding the best response and unit for each call
- Provide customer service to nursing homes to provide wheel care services to patients for doctor appointments and return to the nursing home from the hospital.
Education
Bachelor of Science - Healthcare Administration
Western Governors University
Salt Lake City, Utah05-2027
Diploma - Medical Billing and Coding
Penn Foster College
Scranton, Pennsylvania01.2012
No Degree - Healthcare Management and Administration
National American University
Denver, Colorado01.2008
No Degree - General Studies
Community College of Aurora
Aurora, Colorado01.2006
Skills
- Certified Pharmacy Technician
- Immunization Certified
- State Certified in Colorado
- Medical Billing and Coding Knowledge
- Medical terminology
- Teamwork
- Willingness to Learn
- Technician Product Verification Certified
- HIPAA compliance
- Effective communication skills
- Healthcare regulations
- Critical thinking
- Claim research
- Medical billing procedures
- Pharmacology
- Data entry
- Proficiency in Most Microsoft Office Programs
- Workflow management
- Insurance verification
- Issue research
Goals
My goal is to continue my journey as a Certified Pharmacy Technician. I am working on the requirements for my Advanced Pharmacy Technician Certification. Getting ready to go back to school to finish my bachelor's degree in healthcare administration and management.
Timeline
Prior Authorization Specialist II
Elevance Health
07.2024 - Current
Certified Pharmacy Technician
Kaiser Permanente
12.2022 - 07.2024
Certified Pharmacy Technician
Walgreens
05.2021 - 12.2023
Certified Pharmacy Technician
Swedish Medical Center
01.2008 - 01.2011
Certified Pharmacy Technician
Rite Aid Pharmacy
10.2003 - 08.2008
Certified Pharmacy Technician
Aurora Community Pharmacy
01.2003 - 12.2003
Communications Technician
Action Care Ambulance
01.2002 - 01.2003
Diploma - Medical Billing and Coding
Penn Foster College
Bachelor of Science - Healthcare Administration
Western Governors University
No Degree - Healthcare Management and Administration
National American University
No Degree - General Studies
Community College of Aurora
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