Monica Thompson
Williamstown
Summary
Detail-oriented healthcare professional with experience in clinical documentation review, prior authorization processing, and EMR systems. Seeking to apply strong analytical and problem-solving skills to improve workflow efficiency and support optimal patient care outcomes.
Overview
16
16
years of professional experience
21
21
years of post-secondary education
Work History
PATIENT SUPPORT ADVOCATE
SHIELDS HEALTH SOLUTIONS
07.2023 - Current
- Serve as liaison between patients, providers, pharmacists, and payers to resolve coverage barriers and ensure timely therapy initiation
- Coordinated specialty medication access across commercial, Medicare, and Medicaid plans, facilitating prior authorization, appeals, and financial assistance programs
- Managed end-to-end prior authorization and insurance resolution workflows, minimizing delays in medication access
- Educate and enroll patients into specialty pharmacy programs and support adherence through ongoing outreach and care coordination
- Identified access barriers and collaborated with clinical and operational teams to enhance specialty pharmacy workflows
- Maintain detailed patient support documentation and case tracking across pharmacy and EMR platforms
- Document authorization status, payer requirements, and patient communications within EMR systems to maintain accurate clinical records
CERTIFIED PA REP
CVS CAREMARK
12.2021 - 07.2023
- Processed prior authorization requests via PBM systems, including electronic submissions and inbound provider communications
- Conducted benefit investigations to verify coverage, formulary status, and authorization requirements across commercial, Medicare, and Medicaid plans
- Identified documentation gaps and coordinated with provider offices to secure clinical information for timely medication approval
- Reviewed clinical documentation (provider notes, labs, diagnostics) to determine completeness and alignment with payer prior authorization criteria
- Entered authorization determinations and case updates within PBM and pharmacy systems, ensuring accurate records and audit readiness
- Liaised between providers, payers, and patients to effectively resolve authorization and coverage issues for specialty medications
- Ensured adherence to HIPAA, SOPs, and payer guidelines in case review activities to uphold quality and compliance standards
PT ENGAGEMENT COORDINATOR
CARDINAL HEALTH
11.2019 - 11.2021
- Conducted telephonic outreach to Medicare Part D members, enhancing medication adherence and identifying therapy barriers
- Collaborated with providers and pharmacies to clarify medication therapies and resolve adherence or access issues
- Assisted pharmacists with Comprehensive Medication Reviews (CMRs) and Targeted Medication Reviews (TMRs), streamlining pre-visit data collection and medication profile updates
- Reviewed MTM eligibility databases and coordinated pharmacist consultations, improving scheduling efficiency
- Documented MTM services and patient interactions in Outcomes MTM platform in compliance with CMS requirements
- Supported Medicare Star Ratings initiatives through adherence outreach, documentation accuracy, and performance tracking
- Maintained accurate medication lists and patient records across MTM and pharmacy systems
CERTIFIED PHARMACY TECHNICIAN
WALGREENS
11.2018 - 09.2021
- Processed prescriptions and insurance claims, ensuring accurate data entry, timely adjudication, and effective issue resolution
- Processed prescriptions and insurance claims, including data entry, adjudication, and issue resolution
- Communicated with patients, providers, and insurers to effectively resolve prescription and coverage issues
- Maintained accurate patient profiles and pharmacy records while ensuring compliance with HIPAA and state regulations
RETAIL PHARMACY TECHNICIAN
CVS
07.2018 - 11.2018
- Coordinated front-end pharmacy support for prescription drop-off and pickup, ensuring efficient register operations
- Provided front-end pharmacy support, including prescription drop-off and pickup coordination and register operations
- Managed pharmacy phone inquiries and directed clinical questions to pharmacists or senior technicians for timely resolution
- Facilitated inventory stocking and organized pharmacy work areas, enhancing overall operational efficiency
LEAD OFFICE ADMIN
NEW BEGINNINGS LLC
05.2010 - 09.2018
- Supervised and supported office staff to ensure efficient workflow.
- Ensured compliance with company policy and procedures.
- Collaborated with vendors and suppliers to maintain office equipment and services.
- Tracked and managed office expenses.
Education
BS - BEHAVIORAL HEALTH SCIENCE
WILMINGTON UNIVERSITY
New Castle, DE 06.2005 - 05.2026
Skills
- Patient advocacy
- Prior Authorization
- Insurance Navigation
- Specialty Pharmacy
- Billing/ Reimbursement
- Medication Access
- Clinical Documentation
- EMR workflow
Personal Information
Title: Certified Pharmacy Technician
Timeline
PATIENT SUPPORT ADVOCATE
SHIELDS HEALTH SOLUTIONS
07.2023 - Current
CERTIFIED PA REP
CVS CAREMARK
12.2021 - 07.2023
PT ENGAGEMENT COORDINATOR
CARDINAL HEALTH
11.2019 - 11.2021
CERTIFIED PHARMACY TECHNICIAN
WALGREENS
11.2018 - 09.2021
RETAIL PHARMACY TECHNICIAN
CVS
07.2018 - 11.2018
LEAD OFFICE ADMIN
NEW BEGINNINGS LLC
05.2010 - 09.2018
BS - BEHAVIORAL HEALTH SCIENCE
WILMINGTON UNIVERSITY
06.2005 - 05.2026