Lycette Carlton
Philadelphia,PA
Summary
Efficient Prior Authorization Specialist known for high productivity and ability to complete tasks swiftly. Possesses specialized skills in insurance verification, medical coding (ICD-10 and CPT), and regulatory compliance. Excels at communication, problem-solving, and time management, ensuring smooth operation within healthcare settings.
Overview
1
1
Certification
20
20
years of professional experience
Work History
Prior Authorization Specialist
Penn Medicine
03.2024 - Current
- Processed and submitted high volumes of prior authorization requests for specialty medications and medical procedures, ensuring high first-pass approval rates.
- Utilized electronic platforms like CoverMyMeds and various insurance portals to streamline electronic prior authorizations (ePA) and improve real-time tracking efficiency.
- Denial Management: Investigated coverage denials and managed appeal submissions by supplying supplemental medical justifications within tight payer deadlines.
- Coordinated with patients, pharmacies, and insurance case managers to resolve coverage gaps, minimizing treatment delays and enhancing patient care.
Specialty Benefits Investigation Pharmacy Technician
University of Pennsylvania Health System
11.2021 - 03.2024
- Specialty Pharmacy Representatives assist patients, physicians, and pharmacists in the completion of benefit investigations, financial assistance applications, refill/adherence activities, and other programs that drive optimal outcomes for Penn Specialty Pharmacy
- Documented communications and interactions in patient medical records, keeping care team informed and flagging critical issues for timely resolution.
- Managed inbound and outbound calls from patients and physician offices about orders and prescription refill information for specialty medications.
- Collaborated with co-workers to foster a supportive work environment, visitors, and other staff consistent with the values of Penn
Pharmacy Technician
University of Pennsylvania Health System
11.2019 - 11.2021
- Processed prescriptions accurately and efficiently, ensuring timely medication delivery
- Prepared and dispensed medications accurately for patients
- Measured and mixed medications according to established guidelines
- Communicated effectively with patients and hospital staff to ensure understanding of medications and instructions
- Employed technology to produce accurate labels for medication packages
- Processed insurance claims to ensure timely and accurate patient billing
- Oversaw pharmacy inventory management to sustain appropriate stock levels and minimize shortages
Lead CPhT
CVS
12.2006 - 08.2021
- Organizes medications for pharmacist to dispense by reading and inputting medication orders and prescriptions; preparing labels; calculating quantities; counting pills and packaging medication.
- 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.
- Assigned targeted tasks to technicians during training sessions, improving their skill development.
- Created weekly schedules for over 15 employees, optimizing shift coverage and operational efficiency.
- Assisted health care providers and patients by greeting them and addressing inquiries, facilitating timely referrals to the pharmacist.
- Maintains a safe and clean pharmacy by complying with procedures, rules, and regulations.
Direct Care Worker
365 Health
Philadelphia, PA
02.2018 - 11.2019
- Provided caring support to clients, improving daily comfort and quality of life.
- Coordinated daily activities that promoted independence and well-being.
- Addressed personal care needs to enhance client comfort while preserving comfort and dignity.
- Helped with mobility transfers using walkers, wheelchairs, and safe lifting techniques.
- Monitored medication reminders and daily care routines with reliable follow-through.
- Provided medication reminders and daily care routine support to enhance client adherence and well-being.
- Facilitated medication adherence to improve client health and consistent daily care through reminder support.
Education
Associate in Arts (AA) -
Community College of Philadelphia
Philadelphia, PA05-2003
Skills
- Insurance verification
- HIPAA compliance
- Medical coding expertise
- Medical terminology
- Prior authorizations
- Payer portals
Certification
- PTCB Certification, Pennsylvania Pharmacy Technician License
Timeline
Prior Authorization Specialist
Penn Medicine
03.2024 - Current
Specialty Benefits Investigation Pharmacy Technician
University of Pennsylvania Health System
11.2021 - 03.2024
Pharmacy Technician
University of Pennsylvania Health System
11.2019 - 11.2021
Direct Care Worker
365 Health
02.2018 - 11.2019
Lead CPhT
CVS
12.2006 - 08.2021
Associate in Arts (AA) -
Community College of Philadelphia