LISA BANKS
Mesa,AZ
Summary
Driven professional with several years of experience facilitating referrals and obtaining authorizations and pre-certifications. Seasoned industry veteran at managing referral verification prior to patient appointments. Devoted to continually enforcing practice procedures, requirements and regulations.
Overview
9
9
years of professional experience
Work History
Referral Specialist
Centene
Mesa, AZ
08.2022 - 07.2023
- Coordinated patient referrals to ensure timely access to healthcare services.
- Participated in staff meetings and provided feedback on ways to improve procedures related to referral processing.
- Entered confidential patient information and updated electronic records in database.
- Provided support to referring physicians in obtaining pre-authorization for services as necessary.
Pharmacy Benefit Specialist
APRIA HEALTHCARE
05.2018 - 09.2022
- Managing prescription and referral intake and data entry
- Resolving discrepancies related to patient, prescriber or insurance information
- Maintain strict HIPAA compliance and privacy standards
- Perform processing duties for the branch; including, but not limited to, creating, and working with new orders, reviewing multiple systems simultaneously to assist customers, confirming delivery appointments.
- Comply with all federal and state laws, rules and regulations governing the practice of pharmacy and the delivery of medical equipment and supplies.
- Durable medical equipment
Pharmacy Help desk
Med-Impact
03.2017 - 11.2017
- Answered inbound calls regarding issues related to claim transactions, reimbursement, payment, and other required information for electronic and paper claims.
- Temp
Clinical Service Representative
CVS HEALTH
09.2014 - 05.2016
- Communicate clearly and concisely with callers while identifying their needs
- Managing faxes in the electronic PA fax platform
- Prioritize and organize daily responsibilities in order to meet all deadlines
- Updating patient information and providers' demographics
- Assisted retail and mail order pharmacies with rejected claims, compounding cost and claim overrides.
- Consult and coordinate with various internal departments to obtain information and ensure resolution for callers’ needs.
- Track and document inbound support requests and ensure proper notation of members' problems and issues.
- Maintained confidentiality of all patient information according to HIPAA regulations.
Education
High School Diploma -
Normandy Technical High School /St. Louis Job Corp
St Louis, MO05-2002
Skills
- Referral processing
- Pre-authorization
- Insurance verification
- Claims processing
- Regulatory knowledge
- HIPAA compliance
- Medical terminology
- Electronic records management
- Authorization systems
- Workflow optimization
- Coordination
- Customer service
Timeline
Referral Specialist
Centene
08.2022 - 07.2023
Pharmacy Benefit Specialist
APRIA HEALTHCARE
05.2018 - 09.2022
Pharmacy Help desk
Med-Impact
03.2017 - 11.2017
Clinical Service Representative
CVS HEALTH
09.2014 - 05.2016
High School Diploma -
Normandy Technical High School /St. Louis Job Corp