Le-Shea Duhon
Vacherie,Louisiana
Summary
Pharmacy Technician with 19+ years of call center and home infusion experience. Expert in verifying patient data and billing information. Experience in Louisiana, Texas and Florida Insurance and Authorizations
Talented customer service professional, able to understand and resolve issues. Driven to exceed expectations and contribute expertise to team success. Skilled in exceeding goals and company expectations by expanding client base and maintaining high standards of customer service.
Hardworking and accustomed to fast-paced call center environments.
Overview
19
19
years of professional experience
Work History
Prior Authorization/Senior Clinical Administrative Coordinator
Optum Infusion Pharmacy
2018.06 - Current
- Provided accurate information to all parties, including patients, insurance providers, healthcare staff and office personnel by using effective written and verbal communication skills.
- Notified ordering providers of denied authorizations.
- Clarified patient inquiries and questions to update patient account information in computer system.
- Applied knowledge of Medicare, Medicaid and third-party payer requirements utilizing on-line eligibility systems to verify patient coverage and policy limitations.
- Scheduled peer to peer reviews for physicians to discuss medical necessity with insurance providers.
- Identified reasons behind denied claims and worked closely with insurance carriers to promote resolutions.
- 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.
- Followed all Medicare, Medicaid, HIPAA, and private insurance regulations and requirements.
- Coordinated medical referrals for patients, ensuring seamless transitions between providers and continuity of care.
- Increased department productivity by optimizing workflows and implementing time-saving administrative processes.
- Managed high volume of incoming calls, providing prompt assistance to patients, physicians, and insurance companies.
- Collaborated with multidisciplinary teams to develop comprehensive care plans for patients, resulting in improved health outcomes.
- Ensured compliance with healthcare regulations and policies, maintaining accurate patient records and documentation.
- Implemented electronic health record system, leading to greater accuracy in data management and streamlined information sharing among clinical teams.
- Built strong relationships with patients and families for optimized care satisfaction.
Prior Authorization Tech/Senior Clinical Administrative Coordinator
Soleau's Vital Care
2016.07 - 2018.06
- Verify the correct authorization form and plan to submit the authorization,.
- Gather all necessary information from the Doctor's office to complete the authorization form.
- Responsible for submission of authorization form to the Insurance plan.
- Notifying appropriate staff of approved/denied medications.
- Use proficiency with medical coding, such as ICD-10 codes.
- Responsible for maintaining required spreadsheets.
- Answer phone queues and process faxes within established standards.
- Data enters authorizations into the system.
- Responsible for all follow up phone calls to the insurance company for status of authorization.
- Responsible for all documentation of authorization statuses.
- Responsible for monitoring agents aux modes, breaks, and schedules.
- Responsible for assistant agents with questions in regards to cases.
- Responsible for side by side listening with agents phone calls.
- Responsible for reporting to team leads and mangers about agents.
- Answered and screened phone calls for the staff pharmacist in a friendly, efficient manner.
- Communicated directly with doctors' offices via telephone, fax and email.
- Efficiently answered multi-line phone and processed high volume of order requests from nurses, doctors and pharmacists.
- Coordinated medical referrals for patients, ensuring seamless transitions between providers and continuity of care.
- Managed high volume of incoming calls, providing prompt assistance to patients, physicians, and insurance companies.
- Implemented electronic health record system, leading to greater accuracy in data management and streamlined information sharing among clinical teams.
- Strengthened patient-provider relationships through timely communication and attentive service during office visits.
- Facilitated efficient billing processes by verifying insurance coverage information and submitting claims promptly.
- Ensured compliance with healthcare regulations and policies, maintaining accurate patient records and documentation.
- Served as liaison between clinical departments, fostering collaboration on initiatives aimed at improving patient care services across the organization.
Pharmacy Technician Supervisor
Old Gretna Pharmacy
2013.05 - 2016.03
- Helps health care providers and patients by greeting them in person and by phone, answering questions and requests, referring inquiries to the pharmacist.
- Maintains pharmacy inventory by checking pharmaceutical stock to determine inventory level, anticipating needed medications and supplies, placing and expediting orders, verifying receipt, removing outdated drugs.
- Maintains a safe and clean pharmacy by complying with procedures, rules, and regulations.
- Organizes medications for pharmacist to dispense by reading medication orders and prescriptions, preparing labels, calculating quantities, assembling intravenous solutions and other pharmaceutical therapies.
- Supply medicines to patients, whether on prescription or over the counter.
- Maintains records by recording and filing physicians orders and prescriptions.
- Generates revenues by calculating, recording, and issuing charges.
- Prepares reports by collecting and summarizing information.
- Verify insurance benefits and resolve rejected claims.
- Contributes to team effort by accomplishing related results as needed.
- Entered new patient profiles and prescriptions into medication input software system.
- Adhered to regulatory guidelines for workplace safety and customer confidentiality.
- Created new customer profiles and updated changes such as demographics, allergies, and new medications in pharmacy computer systems.
Pharmacy Technician/Intake Coordinator
Bioscript
2011.04 - 2013.02
- Collaborated with managers and other team members to solve difficult or complex customer issues.
- Consulted with insurance company representatives to complete claims processing, resolve concerns, and reconcile payments.
- Resolved third-party billing, computer system and customer service issues.
- Supported office staff and operational requirements with administrative tasks.
- Completed intake assessment forms and filed clients' charts.
- Met or exceeded revenue objectives by promoting products to customers during service
- Supported customer service goals and enhanced relations through friendly, knowledgeable and positive communication.
- Answered incoming phone calls and addressed questions from customers and healthcare providers.
- Streamlined prescription processing with accurate data entry and verification of patient information.
- Performed various pharmacy operational activities with strong commitment to accuracy, efficiency, and service quality.
- Enhanced pharmacy workflow by assisting pharmacists with medication dispensing, labeling, and packaging.
- Counted and labeled prescriptions with correct item and quantity.
- Assisted pharmacist by filling prescriptions for customers and responding to patient questions regarding prescription and medication-specific issues.
- Improved patient satisfaction by efficiently processing prescriptions and managing inventory in a timely manner.
- Reduced medication errors by diligently cross-checking medications against patients'' profiles before dispensing.
- Stocked, labeled, and inventoried medication to keep accurate records.
- Ensured patient safety by strictly following drug storage guidelines, including proper temperature and light exposure control.
Pharmacy Technician
Fred's Pharmacy
2005.08 - 2013.01
- Answered incoming phone calls and addressed questions from customers and healthcare providers.
- Streamlined prescription processing with accurate data entry and verification of patient information.
- Restocked pharmacy shelves with current merchandise to drive consistent peripheral sales.
- Performed various pharmacy operational activities with strong commitment to accuracy, efficiency, and service quality.
- Counted and labeled prescriptions with correct item and quantity.
- Ordered medicines daily to replenish stock and increase inventory in anticipation of need.
Education
High School Diploma -
St James High
Vacherie, United States05.1998
Skills
- Exceptional Customer Service
- Pharmacy operations
- Team Leadership
- Detail-oriented
- Time management
- Insurance verification
- Problem-solving skills
- Excellent telephone etiquette
- Strong decision-making ability
- Inventory management
- HIPAA trained
- Efficient and accurate
Timeline
Prior Authorization/Senior Clinical Administrative Coordinator
Optum Infusion Pharmacy
2018.06 - Current
Prior Authorization Tech/Senior Clinical Administrative Coordinator
Soleau's Vital Care
2016.07 - 2018.06
Pharmacy Technician Supervisor
Old Gretna Pharmacy
2013.05 - 2016.03
Pharmacy Technician/Intake Coordinator
Bioscript
2011.04 - 2013.02
Pharmacy Technician
Fred's Pharmacy
2005.08 - 2013.01
High School Diploma -
St James High
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