Mariama Kante
Avondale,AZ
Summary
Prior Authorization Coordinator adept at resolving complex claims and enhancing patient care. Proficient in insurance verification and compliance, leveraging effective communication to streamline processes. Recognized for improving authorization turnaround times and fostering collaboration among healthcare providers, ensuring optimal patient outcomes.
Overview
6
6
years of professional experience
1
1
Certification
Work History
Prior Authorization Coordinator
Optum, UnitedHealthcare
12.2024 - Current
- Verify insurance eligibility and update member records accurately.
- Research copays, deductibles, and shipment tracking for medications.
- Communicate with doctors, pharmacists, and patients to resolve prior authorization issues.
- Maintain professionalism during patient and provider interactions.
- Perform follow-up calls to ensure resolution of claims and medication issues.
- Reviewed prior authorization requests for medical services and treatments.
- Collaborated with healthcare providers to gather necessary documentation.
- Analyzed clinical information to determine coverage eligibility and compliance.
- Educated staff on prior authorization procedures and best practices.
- Created and maintained accurate documentation for all prior authorization activities.
- Facilitated resolution between providers, payers, patients, and internal staff on matters related to prior authorizations.
- Evaluated patient eligibility and benefits for requested procedures and medications.
Pharmacy Technician/Prior Authorization Coordinator
Amazon Pharmacy (PillPack)
10.2020 - 12.2024
- Reviewed and processed prior authorization requests for prescription medications in compliance with insurance guidelines and state regulations.
- Prepared and labeled prescription medications accurately.
- Packaged and shipped completed prescriptions according to protocol.
- Assisted pharmacists in prescription fulfillment, in compliance with state pharmacy regulations.
- Coordinated with prescribers, patients, and insurance providers to gather necessary documentation for approvals.
- Communicated with healthcare providers to clarify prescription orders and resolve clinical or insurance issues.
- Assisted pharmacists in preparing prescription orders and patient consultations.
- Collaborated with healthcare professionals to coordinate patient care services.
- Resolved customer complaints in a timely manner while maintaining professionalism at all times.
- Prepared prescription transfers to other pharmacies.
- Maintained accurate records of all prior authorization requests and outcomes.
- Performed detailed medical reviews of prior authorization request, following established criteria and protocols.
- Applied knowledge of Medicare, Medicaid and third-party payer requirements utilizing on-line eligibility systems to verify patient coverage and policy limitations.
ADA Caregiver
Private Client Services
09.2019 - 12.2024
- Provided personal care assistance including bathing, grooming, and feeding.
- Supported patients with mobility and transportation to medical appointments.
- Offered companionship and emotional support to improve overall well-being.
- Assisted in medication reminders and light housekeeping duties.
Education
Associates Degree - Pharmacy
Tech Skills
ColumbusSkills
- Pharmacy Law & Compliance
- EMR
- Insurance Portals
- Prior Authorizations & Claims Resolution
- Basic ICD9/10 & CPT code familiarity
- Ability to learn and use multiple CRM Software program as needed
- Healthcare compliance
- Insurance verification
- Claims resolution
- Insurance guidelines
- Customer service
- Prescription coordination
- Medical terminology
- HIPAA compliance
- ICD-10 coding
- Pharmacy benefit management
- Claims processing experience
- Medical terminology knowledge
- Medical appeals handling
- Effective communication skills
- Performance metrics analysis
Certification
Certified Pharmacy Technician (PTCB)
AZ State Board of Pharmacy
Timeline
Prior Authorization Coordinator
Optum, UnitedHealthcare
12.2024 - Current
Pharmacy Technician/Prior Authorization Coordinator
Amazon Pharmacy (PillPack)
10.2020 - 12.2024
ADA Caregiver
Private Client Services
09.2019 - 12.2024
Associates Degree - Pharmacy
Tech Skills
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