Mir Ali
McKinney,TX
Summary
Pharmacy Technician with 12+ years of prior authorization and retail pharmacy experience. Talented at managing prior authorization, appeals, drug inventory , ordering medications and verifying patient data and billing information.
Talented customer service professional, able to understand and resolve PA issues. Driven to exceed expectations and contribute expertise to team success. Skilled in exceeding goals and company expectations by expanding client base and maintaining high standards of customer service.
Hardworking and accustomed to fast-paced call center environments.
Overview
12
12
years of professional experience
Work History
Prior Authorization Tech/ Subject Matter Expert
CVS Health
03.2020 - 06.2024
- Verify correct authorization form and plan to submit authorization.
- Gather all necessary information from Doctor's office to complete authorization form.
- Responsible for submission of authorization form to Insurance plan.
- Notifying appropriate staff of approved/denied medications.
- Use proficiency with medical coding, such as ICD-10 codes.
- Responsible for maintaining required spreadsheets.
- Answer phone queues and process faxes within established standards.
- Data enters authorizations into system.
- Responsible for all follow up phone calls to insurance company for status of authorization.
- Responsible for all documentation of authorization statuses.
- Responsible for monitoring agent’s aux modes, breaks, and schedules.
- Responsible for assistant agents with questions regarding cases.
- Answered and screened phone calls for staff pharmacist in friendly, efficient manner.
- Communicated directly with doctors' offices via telephone, fax and email.
- Efficiently answered multi-line phone and processed high volume of order requests from nurses, doctors and pharmacists.
- Improved user productivity and efficiency through system training and support.
Prior Authorization Pharmacy Technician
CVS Health
06.2017 - 03.2020
- Provided accurate information to all parties, including patients, insurance providers, healthcare staff and office personnel by using effective written and verbal communication skills.
- Notified ordering providers of denied authorizations.
- Clarified patient inquiries and questions to update patient account information in computer system.
- Applied knowledge of Medicare, Medicaid and third-party payer requirements utilizing on-line eligibility systems to verify patient coverage and policy limitations.
- Scheduled peer to peer reviews for physicians to discuss medical necessity with insurance providers.
- Identified reasons behind denied claims and worked closely with insurance carriers to promote resolutions.
- Determined which party would be liable for payment on medical services by thoroughly reviewing patient insurance coverage.
- Performed detailed medical reviews of prior authorization request, following established criteria and protocols.
- Followed all Medicare, Medicaid, HIPAA, and private insurance regulations and requirements.
- Reduced errors in prior authorization process by diligently reviewing patient records, insurance details, and medication interactions.
Pharmacy Technician
Retail CVS Pharmacy
06.2012 - 03.2017
- Helps health care providers and patients by greeting them in person and by phone, answering questions and requests, referring inquiries to pharmacist.
- 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.
- Maintains safe and clean pharmacy by complying with procedures, rules, and regulations.
- Organizes medications for pharmacist to dispense by reading medication orders and prescriptions, preparing labels, calculating quantities, assembling intravenous solutions and other pharmaceutical therapies.
- Supply medicines to patients, whether on prescription or over counter.
- Maintains records by recording and filing physicians orders and prescriptions.
- Streamlined prescription processing with accurate data entry and verification of patient information.
- Generates revenues by calculating, recording, and issuing charges.
- Verify insurance benefits and resolve rejected claims.
- Contributes to team effort by accomplishing related results as needed.
- Adhered to regulatory guidelines for workplace safety and customer confidentiality.
- Created new customer profiles and updated changes such as demographics, allergies, and new medications in pharmacy computer systems.
- Enhanced pharmacy workflow by assisting pharmacists with medication dispensing, labeling, and packaging.
- Solved customer problems in-person or over telephone by providing assistance with placing orders, navigating systems, and locating items.
Education
Bachelor of Science - Pharmacology
Dhaka University
11.2004
Skills
- Exceptional Customer Service
- Healthcare Industry Knowledge
- HIPAA Compliance and trained
- Client Service
- Electronic Records Management
- Follow-up skills
- Pharmacy operations
- Detail-oriented
- Time management
- Insurance verification
- Problem-solving skills
- Excellent telephone etiquette
- Strong decision-making ability
- Inventory management
- Efficient and accurate
Affiliations
- Worked as Faculty of pharmacology in Richland community college, Dallas TX for 3 years.
- Texas Board of Pharmacy since 2012
- License no. 200413 (Active)
Timeline
Prior Authorization Tech/ Subject Matter Expert
CVS Health
03.2020 - 06.2024
Prior Authorization Pharmacy Technician
CVS Health
06.2017 - 03.2020
Pharmacy Technician
Retail CVS Pharmacy
06.2012 - 03.2017
Bachelor of Science - Pharmacology
Dhaka University