CHRISTINA DIAZ-JONES
Florida
Summary
Driven Pharmacy Technician with proven track record and success in building strong relationships with patients and clients. Detail-oriented with a commitment to maintaining high-quality assurance and HIPPA standards when assisting members, providers, or third party representatives. History of meeting company goals utilizing consistent and organized practices. Skilled in working under pressure and adapting to new situations and challenges to best enhance the organizational brand.
Overview
9
9
years of professional experience
1
1
Certification
Work History
Senior Pharmacy Resolution Specialist
Centene
11.2022 - Current
- A subject matter expert, handles more complex pharmacy issues promptly and professionally.
- Respond to escalated calls from members, provider/physician's offices and pharmacies approximately 30 calls daily. Achieves average handle time of 6 minutes or less.
- Answers and conducts inbound and outbound calls with members and provider offices to provide resolution to claims (i.e.: additional information requests and medication determination updates)
- Thoroughly researches issues and takes appropriate action to resolve them within turnaround time requirements and quality standards
- Assists team members often guiding them to appropriate resolution of more complex and difficult inquiries. Participates in training of less experienced staff, including opportunity for job shadowing
Pharmacy Resolution Specialist
Centene Corporation
10.2019 - 11.2022
- Obtain verbal authorizations and request detailed clinical information from prescribers
- Performs reviews of requests for coverage determination made by physicians and pharmacies for use of prescription drugs that are non-formulary, have prior authorization requirements, and have exceeded quantity or cost limits of a prescription claim.
- Participates in maintaining consistent processes for development, communication, and training on updated policies and procedures.
- Good knowledge of Quality/Process Improvement techniques and currently achieving department goals of over 95%.
Pharmacy Technician (Call Center)
TTEC
07.2018 - 04.2019
- Conducted data entry of over 40 prescriptions per day for prior authorization requests from providers received by telephone and/or fax.
- Communicated selected prior authorization criteria, pharmacy benefit coverage, and formulary alternatives to physicians.
- Reviewed and verified patient information and insurance provider information including commercial plans, Medicare, and Medicaid.
- Served as a training resource, mentor, and coach to others.
- Demonstrated, advocated, and reinforced a positive team environment.
PBX Supervisor
Daily Management Inc.
01.2015 - 08.2018
- Oversaw front desk operations of arrivals and departures for guests with an eye for hotel reputation and staff productivity at a 2900 unit resort.
- Trained and supervised front desk and PBX agents on correct procedures, compliance requirements, and performance strategies. Provided constructive feedback and performance evaluations that boosted morale and led to increasing in employee retention.
- Resolved guest issues with rooms or reservations with knowledgeable and friendly service.
Education
Associates Of Arts - Psychology
Valencia College
Orlando, FL07.2019
Pharmacy Technician Certification -
Concorde Career Institute
Orlando, FL07.2018
Skills
- Supervisory Experience
- Highly organized and detail-oriented
- Knowledge of pharmacy and medical benefits
- Excellent verbal and written communication skills
- Professional listening and consultative skills due to 7 years of call center experience
- Knowledge of pharmacy and medical benefits
- Medicare, Medicaid & Insurance Claim Processing
Certification
Registered Pharmacy Technician
Basic Life Support (BLS) Certification
Cardiopulmonary Resuscitation (CPR) Certification
Timeline
Senior Pharmacy Resolution Specialist
Centene
11.2022 - Current
Pharmacy Resolution Specialist
Centene Corporation
10.2019 - 11.2022
Pharmacy Technician (Call Center)
TTEC
07.2018 - 04.2019
PBX Supervisor
Daily Management Inc.
01.2015 - 08.2018
Associates Of Arts - Psychology
Valencia College
Pharmacy Technician Certification -
Concorde Career Institute
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