NATIKA READOUS-PRICE
Northville,MI
Summary
Customer-focused individual with a passion for delivering exceptional service. Strong interpersonal skills with a talent for effectively addressing concerns. Committed to improving customer satisfaction and driving positive outcomes.
Overview
6
6
years of professional experience
Work History
Pharmacy Benefit Representative
ProCare Rx
09.2024 - Current
- Perform pharmacy and DMEPOS authorizations and modifications as required and approved by client.
- Manage the coordination of prescription drug services between healthcare providers, pharmacies, and insurance companies.
- Develop and maintain client relationships to ensure satisfaction with pharmacy benefits services.
- Research, analyze and resolve complex claimant inquiries regarding pharmacy benefits.
- Process paper claim invoices for payment, verifying accuracy and resolving discrepancies with vendors.
- Collaborate closely with team members to achieve project objectives and meet deadlines.
- Prepare reports detailing claimant benefit usage statistics and trends.
Delivery Station Associate
Amazon
06.2024 - 11.2024
- Operated conveyor belt systems to move items from one station to the next.
- Organized packages into designated containers for delivery.
- Provided support during peak periods by working extended shifts when required.
- Sorted and placed materials or items on racks, shelves or bins for transport to recipient or destination.
Medical Information Specialist
Blue Cross Blue Shield of MI
10.2021 - 04.2023
- Verified that patients had proper insurance coverage prior to procedures or appointment scheduling.
- Accessed third-party insurance databases to identify coverage of benefits.
- Assisted physicians with finalizing prior auth approvals for medical procedures.
- Retained strong medical terminology understanding in effort to better comprehend procedures.
- Transmitted medical records and other correspondence by mail, e-mail, or fax.
Insurance Verification Specialist
CVS Caremark Mail Services Pharmacy
06.2019 - 08.2021
- Updated patient and insurance data and input changes into company computer system.
- Accessed third-party insurance databases to identify coverage of benefits.
- Navigated through multiple online systems to obtain documentation.
- Coordinate prescription deliveries and retail refills for patients
- Completed relevant insurance and other claim forms.
Education
Certification - Pharmacy Technician
DORSEY COLLEGE
Southgate, MI06.2017
Skills
- CRM Systems
- Data Entry
- Medical Terminology Proficiency
- Technical Proficiency
- Microsoft Programs
- Conflict Resolution
- Excellent Interpersonal Skills
- Epic, MARx, CMS, Citrix, Cisco experience
Timeline
Pharmacy Benefit Representative
ProCare Rx
09.2024 - Current
Delivery Station Associate
Amazon
06.2024 - 11.2024
Medical Information Specialist
Blue Cross Blue Shield of MI
10.2021 - 04.2023
Insurance Verification Specialist
CVS Caremark Mail Services Pharmacy
06.2019 - 08.2021
Certification - Pharmacy Technician
DORSEY COLLEGE
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