Maya Fisher
Clio,USA
Summary
Dynamic Prior Authorization Technician with Centene/Spectraforce, skilled in insurance eligibility verification and prior authorization processing. Proven ability to enhance workflow efficiency and improve patient outcomes through effective communication and team collaboration. Committed to regulatory compliance and delivering exceptional customer service while maintaining HIPAA standards. Skilled Prior Authorization Technician with background in reviewing and processing medical insurance claims, ensuring compliance with policy regulations. Strengths include knowledge of pharmacy protocols, ability to interpret physician orders accurately, and superior communication skills to liaise between providers and insurance companies effectively. Previous work has resulted in streamlined authorization processes, improved efficiency, and maintained patient satisfaction.
Overview
6
6
years of professional experience
Work History
Prior Authorization Technician
Centene/ Spectraforce Michigan
Detroit, MI
12.2024 - Current
- Collaborated with insurance companies to clarify coverage details and resolve issues related to prior authorization.
- Educated healthcare providers on prior authorization requirements and insurance formulary changes.
- Adhered to HIPAA regulations while handling confidential patient information.
- Answered inquiries from providers, members, pharmacies. regarding status of prior authorization requests.
- Verified insurance eligibility for each requestor.
- Reviewed and processed prior authorization requests for accuracy, completeness, and compliance with established guidelines.
- Participated in multidisciplinary team meetings to discuss complex cases requiring prior authorization.
- Identified opportunities for improvement in processes and procedures related to prior authorizations.
- Evaluated patient eligibility and benefits for requested procedures and medications.
- Developed and implemented process improvements to enhance efficiency and accuracy of prior authorization workflows.
- Followed up on pending prior authorization requests to ensure timely processing.
- Proofread documents carefully to check accuracy and completeness of all paperwork.
- Communicated authorization decisions, including approvals and denials, to healthcare providers and patients.
- Participated in training sessions related to new systems or processes involving prior authorizations.
Pharmacy Technician
Ideal Pharmacy
Flushing, MI
08.2024 - 12.2024
- Provided exceptional customer service, addressing patient questions and concerns with empathy.
- Resolved customer complaints in a timely manner while maintaining professionalism at all times.
- Supported pharmacy operations by answering phone calls and directing queries appropriately.
- Prepared medications for dispensing by counting, pouring, labeling, and verifying doses.
- Cleaned and maintained equipment or work areas according to prescribed methods.
Certified Pharmacy Technician
Rite Aid
Flushing, MI
10.2019 - 07.2024
- Streamlined pharmacy operations through effective organization of supplies, workspace layout optimization, and process improvements.
- Collaborated with pharmacists to resolve medication-related issues, optimizing patient outcomes.
- Communicated directly with doctors offices via telephone, fax and email.
- Resolved third-party billing, computer system and customer service issues.
- Participated in continuous professional development opportunities to stay current on industry standards and advancements in pharmaceutical care.
- Performed wide range of pharmacy operations with strong commitment to accuracy, efficiency and service quality.
- Assisted in maintaining a clean and organized work environment, ensuring compliance with safety regulations.
- Reduced medication errors by diligently cross-checking medications against patients' profiles before dispensing.
- Counted, measured and compounded medications following standard procedures.
- Increased overall pharmacy productivity by restocking supplies, organizing shelves, and maintaining cleanliness according to standards.
- Managed opening and closing duties for pharmacy.
- Collected co-payments or full payments from customers.
- Monitored ordering of pharmacy medication stock to maintain streamlined inventory and low overhead.
- Prepared packaging and labels for prescriptions, verifying accuracy of dosage, side effects, interactions, and refill instructions.
Pharmacy Technician
Kroger
Flushing, MI
04.2019 - 09.2020
- Provided exceptional customer service, addressing patient questions and concerns with empathy.
- Resolved customer complaints in a timely manner while maintaining professionalism at all times.
- Assisted customers by answering questions, locating items or referring to pharmacist for medication information.
- Received and stored incoming supplies and informed supervisors of stock needs and shortages.
- Assisted pharmacists in filling prescriptions accurately and efficiently.
- Provided education materials about medications to patients upon request.
- Checked expiration dates on medications to ensure that only unexpired products were dispensed.
- Collaborated with healthcare providers to clarify prescription orders and resolve medication discrepancies.
- Cleaned and maintained equipment or work areas according to prescribed methods.
Education
CERTIFIED - Pharmacy
PHARMACY TECHNICIAN UNIVERSITY
03.2019
CERTIFICATION - HEALTHCARE
Charles Stewart Mott Community College
Flint, MI05.2018
High School Diploma -
Birch Run High School
Birch Run, MI05.2013
Skills
- Drug storage procedures
- Prescription Order Verification
- New Hire Onboarding
- Medical Insurance Claims Processing
- HIPAA
- Insurance Billing
- Order Verification
- Prescription Interpretation
- Drug safety
- Receiving incoming supplies
- Team Collaboration
- Regulatory Compliance
- Insurance Verification
- Medication Dispensing
- Prescription Filling
- Inventory Tracking
- Prior authorization processing
- Insurance eligibility verification
- HIPAA compliance
- Documentation accuracy
- Workflow optimization
- Customer service
References
- Stephen Durbin, NCPHT, sjdurbin17@hotmail.com, 270-302-2876
- Ray Dorhout, Pharmacist, 810-659-8057
- Mehul Patel, Pharmacist, Ideal Pharmacy, 810-348-8358
- William Bueche, Pharmacist, Rite Aid, 8106104167
- Mike Zengerle, Pharmacist, Rite Aid, 8105235587
Timeline
Prior Authorization Technician
Centene/ Spectraforce Michigan
12.2024 - Current
Pharmacy Technician
Ideal Pharmacy
08.2024 - 12.2024
Certified Pharmacy Technician
Rite Aid
10.2019 - 07.2024
Pharmacy Technician
Kroger
04.2019 - 09.2020
CERTIFIED - Pharmacy
PHARMACY TECHNICIAN UNIVERSITY
CERTIFICATION - HEALTHCARE
Charles Stewart Mott Community College
High School Diploma -
Birch Run High School
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