Citrix
MONIQUE MOORE-BROWN
Certified Pharmacy Technician II/Claims Analyst II
Maricopa,AZ
Work Preference
Summary
Healthcare operations professional skilled in claims investigation, patient communication, and pharmacy workflow management. Handles high-volume workloads while maintaining quality and compliance standards. Proven record of improving member satisfaction and streamlining pharmacy processes across multiple settings.
Overview
1
1
PTCB Certification
13
13
years of professional experience
1
1
Arizona State Board of Pharmacy Certification
1
1
Louisiana State Board of Pharmacy Certification
1
1
NPTA Pharmacy Technician Regulatory Compliance Certificate
1
1
AAPC Coursera Insurance Specifics Certificate
1
1
PowerPak MTM for Pharmacy Technicians Certificate
Work History
Patient Care Technician
Express Scripts
Tempe, AZ
09.2020 - 08.2026
- Resolved issues in Pull department by performing tasks related to Pull Rx, including pulling, copying, faxing, processing, data entry, and transcribing customer support notes. Managed overall member communications, navigated multiple systems, and assisted patients in understanding pharmacy benefits by investigating prescription orders.
- Key Contributions:
- Prescription Processing: Accurately read, interpreted, and entered new and refill prescriptions into computer systems, including calculating doses, and confirming directions.
- Investigated insurance coverage, processed benefit verifications, and managed payment and reimbursement requirements to ensure seamless patient access to medications.
- Patient Communication: Answer inbound phone calls, helps enroll new patients, answer non-clinical questions, and resolve medication access or delivery issues.
- Care Coordination: Route unclear or incomplete prescriptions to prescribers for clarification and work with clinical teams to support patient treatment plans.
- Maintained patient profiles and handled records while escalating complex medication or health issues to a licensed pharmacist. Communicated with providers and members for follow-up on prior authorization, appeals, and DOD accounts.
Claims Analyst
Centene Corporation
Tempe, AZ
08.2016 - 04.2020
- Applied policy and provider contract rules to evaluate payable claims and claims requiring further information. Conducted research and analytics in support of an area of business dealing with coordination of benefits (COB). Operated on a variety of pended IDs, which contain special pricing, with supervisors and TLs. Elucidated health insurance coverage for benefits coordination to process claims and maintain records, files, and documents. Managed requests for coverage determination from providers and prioritized those for pharmacist examination. Upheld accountability for claims processing for physician and hospital services, COB, special pricing, refunds, and changes on resubmitted claims. Ratified coverage determination requests using stated criteria. Oversaw client inquiries regarding authorization approvals and PBM online applications. Forwarded coverage determination requests for specialty drugs to delegated vendor and client for processing. Communicated decisions on coverage determination requests to doctors, hospitals, and patients.
- Key Contributions:
- Evaluated payable claims, identified additional information needs, and applied special pricing rules to ensure accurate processing.
- Managed coverage determination workflows, prioritizing pharmacist review cases to expedite resolutions.
- Processed claims for physician and hospital services, including COB, refunds, and resubmissions, ensuring compliance with established guidelines.
- Communicated coverage decisions to providers, hospitals, and members with clarity and accuracy.
- Forwarded specialty drug coverage requests to delegated vendors and monitored resolution.
- Supported development of new post-payment recovery methodologies for improperly coordinated pharmacy claims.
- Utilized Amisys to determine payment and rejection codes, ensuring adherence to departmental standards
- Identified insurance coverage limitations with thorough examinations of claims documentation and related records.
Insurance Specialist
REMIX Ltd.
Phoenix, AZ
01.2015 - 01.2016
- Applied D.0 regulations, CPT 4, ICD 9/10, HCPCS, ASA, and UB-92 coding guidelines to ensure accurate claims processing.
- Verified coverage and authorization requirements through outbound calls to insurance companies, ensuring compliance with policy standards.
- Audited, reviewed, and validated the accuracy of claims data and claims payments. Processed re-verification claims, contacted clients' insurance providers, entered data for claims processing, and obtained prior authorizations while applying healthcare guidelines such as D.0 regulations and coding standards.
- Entered detailed claims information for ENTYVIO and other specialty medications to facilitate timely claims processing.
- Verified claims documentation for regulatory and payer standards.
Certified Pharmacy Technician
QOL Meds-New Orleans
Phoenix, AZ
01.2014 - 01.2015
- Prepared prescriptions by entering patient demographics, drug allergies, and pharmaceutical history into computer systems for accurate processing. Greeted customers at the pharmacy entrance, maintained the drugstore clean, and answered the phone politely. Provided support to pharmacists in filling prescriptions by pulling stock, counting, restocking, packaging, and labeling and pricing prescriptions, bubble packing, mail order, balancing cash drawers and sending receipts to corporates.
- Key Contributions:
- Entered patient demographics, allergy information, and prescription orders with high accuracy.
- Prepared prescriptions by pulling stock, counting, packaging, labeling, and pricing medications.
- Manage inventory through ordering, receiving, rotating, and storing pharmaceutical products.
- Assisted in bubble packing, processing mail orders, and balancing cash drawers to maintain efficient pharmacy operations.
Education
High School Diploma -
Bowen High School
Chicago, IL05-1982
Pharmacy Technician -
Remington College
Baton Rouge, LAAAS degree - Computer Electronics
City Colleges of Chicago
Chicago, ILSkills
- Claims Investigation Management Support & Reporting Customer Service Patient Satisfaction Strong Relationship Building Risk Management Support Quality Assurance Cross-functional Collaboration Complaint Resolution
- Restocking supplies
- Sterilization techniques
- Medication Management
- HIPAA
- POS
- Team collaboration
- Adaptable
Certification
- Certified, AZ Pharmacy Technician - 01/05/2015-10/30/2027
- PTCB,CPhT, 04/10/2012-09/30/2028
- Certified, LA Pharmacy Technician-04/10/2012-06/30/2027
- NPTA/AAPC, Pharmacy Technician Regulatory Compliance Certificate of Completion-10/04/2024
- AAPC/Coursera, Insurance Specifics Certificate-09/11/2025
- PowerPak, Medication Therapy Management National Certificate of Completion-10/21/2017-06/22/2026
Software
ESI
TMW
Prism
RX Claims
Amisys
Cenpas
Trucare
IRIS
Pega
Bluezone
AWS
Workflows
Affiliations
- NABP
- NPTA
- PTCB
- ASHP
Timeline
Patient Care Technician
Express Scripts
09.2020 - 08.2026
Claims Analyst
Centene Corporation
08.2016 - 04.2020
Insurance Specialist
REMIX Ltd.
01.2015 - 01.2016
Certified Pharmacy Technician
QOL Meds-New Orleans
01.2014 - 01.2015
High School Diploma -
Bowen High School
Pharmacy Technician -
Remington College
AAS degree - Computer Electronics
City Colleges of Chicago