Melody Dew
Lake Isabella,CA
Summary
Detail-oriented team player with strong organizational skills. Ability to handle multiple projects simultaneously with a high degree of accuracy.
Overview
7
7
years of professional experience
Work History
Pharmacy Technician-Prior Authorization Specialist
OptumRx
09.2023 - Current
- Provide superior customer service, courtesy, and politeness to callers and staff
- Communicate decisions for pharmacy requests according to clinical guidelines and company policies
- Evaluate pharmacy requests received by phone, facsimile, and electronically
- Communicate decisions to members, providers, and pharmacies
- Perform clinical research to support requests and analyze what further information is needed to complete patient records
- Perform outreach to providers and pharmacies to obtain necessary information related to authorization requests
- Research eligibility verification, coordination of benefits, and Part D benefit verification when necessary
- Maintain accurate and complete documentation of required information following company policies
- Guarantee drug requests comply with all federal and state laws
- Communicate effectively, both internally and externally to enhance the effectiveness of pharmacy services
- Assist members with formulary inquiries
- Answer inquiries in a professional, courteous manner
- Participate in training and in-service education as required, always eager to engage and learn new things
- Participate in company meetings as requested
- Comply with the organization's policies and procedures and maintain confidentiality in accordance with state and federal laws
- Eagerly participate in special projects and perform other duties, as assigned
Pharmacy Technician
The Drugstore
10.2022 - 08.2023
- Provide superior customer service over the phone and in person
- Follow HIPAA policies and guidelines
- Type incoming prescriptions and process refills
- Verify insurance and adjudicate claims
- Keep inventory, place orders, process incoming orders, stock shelves, file invoices
- Fill and maintain Parata machine
- Request refills from provider's offices
- Fill prescriptions to be verified by pharmacist
- Double count controlled substances
- Communicate with customers, physician's offices and insurance companies
- Start prior authorizations when necessary and follow up
- Process recalls and outdates
Pharmacy Technician
Rite Aid
08.2021 - 09.2022
- Provide superior customer service in person and over the phone
- Type incoming prescriptions and process refills
- Fill prescriptions to be verified by pharmacist
- Process incoming orders, file invoices, stock shelves
- Communicate with patients, doctors, insurance companies
- Verify insurance and adjudicate claims
- Double count controlled substances
- Request refills from doctors
- Follow HIPAA policies
- Process outdates and recalls
- Utilize cash register and process payments.
Health Information Management Clerk
Kern Valley Healthcare District
06.2020 - 07.2021
- Processed forms for releasing personal health information
- Followed HIPAA guidelines
- Scanned documents into electronic system
- Supplied clinical staff with required documents and information
- Enhanced the efficiency of health information management processes by streamlining filing systems and implementing digital solutions
- Processed admission and discharge orders promptly and accurately
- Communicated with physicians and other hospital staff
- Kept patient records accurate and up to date
- Communicated with other facilities via phone, fax, mail, and email
- Stocked office supplies.
Admitting Clerk
Kern Valley Healthcare District
12.2017 - 06.2020
- Provided superior customer service
- Followed HIPAA guidelines
- Registered patients for emergency room admission and outpatient procedures
- Operated telephone switchboard and overhead paging system
- Maintained current face sheets for all patients
- Ordered and maintained stock of office supplies
- Supplied clinical staff with required documents and patient information
- Communicated with other facilities via phone, fax, and mail
- Operated postage machine
- Balanced cash drawer at end of day
- Verified patient details and insurance coverage and collected co-pays
Education
Pharmacy Technician License -
Pharmacy Technicians University
Lake Isabella, CA12.2022
High School Diploma -
Centennial High School
Gresham, OR06.2008
Skills
- Problem-solving skills and workflow optimization
- Confidentiality and HIPAA
- Data entry and insurance billing
- Pharmacology knowledge and OTC recommendations
- Pharmacy software proficiency
- Prescription interpretation
- Manual and automated medication dispensing
- Attention to detail and critical thinking abilities
References Available
Upon request
Timeline
Pharmacy Technician-Prior Authorization Specialist
OptumRx
09.2023 - Current
Pharmacy Technician
The Drugstore
10.2022 - 08.2023
Pharmacy Technician
Rite Aid
08.2021 - 09.2022
Health Information Management Clerk
Kern Valley Healthcare District
06.2020 - 07.2021
Admitting Clerk
Kern Valley Healthcare District
12.2017 - 06.2020
Pharmacy Technician License -
Pharmacy Technicians University
High School Diploma -
Centennial High School