LENA L ALDANA
Moreno Valley,CA
Summary
Nationally Certified Pharmacy technician with 19+ years of experience. I’ve worked in a high volume 24 hour retail store, remote position processing prior authorizations and appeals for Medicare and Medicaid members, hardworking, passionate, trustworthy, compassionate and empathetic. Seeking a position in a company where I can grow, nurture my experience and skills.
Overview
19
19
years of professional experience
1
1
Certification
Work History
Prior Authorization and Appeals Coordinator
Centene, Superior Health Services
Remote
03.2021 - Current
- Coordinated appeals processes to ensure compliance with regulatory standards and organizational policies.
- Managed case documentation and maintained accurate records in electronic filing systems.
- Collaborated with legal teams to analyze appeal cases and develop effective strategies for resolution.
- Reviewed and assessed appeal submissions for completeness, accuracy, and adherence to guidelines.
- Levels of operation, specialized in Medicare and Medicaid background; processing intake, secondary, and review before submitting to a pharmacist.
Lead Pharmacy Tech, Certified Pharmacy Technician
CVS Pharmacy
Orange, CA
05.2007 - 04.2021
- Managing daily responsibilities in a high volume store and overseeing others which include: being shadowed for new employees and pharmacy interns, daily cycle counts, placing medication orders, phone calls, captain of PCQ (patient care que) calling patients to ensure medication compliance, prescription processing, insurance prior authorizations, insurance rejections, medical and Medicare processing, filing, faxing, printer fixing, trash, filling medications, working with script pro machine, return to stock, ringing up prescriptions, putting away prescriptions, checking in McKesson and specialty medications, delivery, vacuuming and cleaning surfaces.
- Managing weekly and year round responsibilities which include: prepping for inventory, cleaning shelves, labeling, returning medications 1x1 window, putting medications back on shelf after load, breaking down load, insuring employees follow and keep up to date with modules and yearly inventory.
- Managed flu and COVID clinics
Education
High School Diploma - General High School Curriculum
Fullerton high school
Fullerton, CASkills
- Leadership and management
- Communication skills
- Medicare, Medicaid and Medi-Cal, Exchange HIM and Ambetter background
- Caremark and ESI eligibility and processing
- Outlook
- Word processing
- One note
- Teams
- Excel
- Duo mobile
- Dayforce
- Step actions
- SharePoint
- Inventory management
- Electronic filing systems
- Conflict resolution strategies
- Flu and COVID clinic
- New hire onboarding
- Pharmaceutical calculations
- Compliance training
- Data entry proficiency
- Confidentiality
- Professionalism and ethics
- Medical and Pharmaceutical terminology
- Teamwork and collaboration
- Workflow optimization
- Continuous learning mindset
- Attention to detail
- Multitasking
- Cisco connect
Certification
- Child and baby first Aid/CPR/AED, American red cross, Completion Date: 2021-03, Expiration Date: 2023-03
- Pharmacy immunization administration, American pharmacist associations, Completion Date: 2021-02, Expiration Date: 2024-02
- Pharmacy technician, California state board of pharmacy, Completion Date: 2012-07, Expiration Date: 2027-11
- Certified pharmacy technician, California state board of pharmacy, Completion Date: 2012-07
- Diploma of graduation, State of California, Completion Date: 2005-06
Timeline
Prior Authorization and Appeals Coordinator
Centene, Superior Health Services
03.2021 - Current
Lead Pharmacy Tech, Certified Pharmacy Technician
CVS Pharmacy
05.2007 - 04.2021
High School Diploma - General High School Curriculum
Fullerton high school