Nicole Shook

· Conduct patient insurance benefit investigation and verification for medications and communicate benefits to patients.

· Complete prior authorization forms, assess authorization status with insurers, track status of prescription approval and, when necessary, alert nursing of denial or non-response

· Assist patients with enrollment in patient assistance and co-pay assistance programs, when available.

· Assist patients with obtaining and completing patient assistance applications.

· Contacting specialty pharmacies to order infusion medications.

· Assist Nursing and Case Managers with preparing letters of medical necessity and/or coordinating peer-to-peer conferences.

· Assist Nursing and Case management workflow and enhance patient satisfaction and wellness with efforts to avoid therapy interruptions by assisting with authorizations, manufacturer rebate programs and patient assistance.

• Input all patient data regarding claims and prior authorizations into system accurately.
• Analyzed medical records and other documents to determine approval of requests for authorization.
• Provided prior authorization support for physicians, healthcare providers and patients in accordance with payer guidelines.
• Evaluated clinical criteria for approval or denial of services requiring pre-authorization.
• Responded to inquiries from healthcare providers regarding prior authorization requests.
• Verified eligibility and compliance with authorization requirements for service providers.
• Reached out to insurance carriers to obtain prior authorization for testing and procedures.
• Reviewed appeals for prior authorization requests and communicated with payers to resolve issues.
• Researched denied claims and contacted insurance companies to resolve these issues.
• Fielded telephone inquiries on authorization details from plan members and medical staff.
• Obtained and logged accurate patient insurance and demographic information for use by insurance providers and medical personnel.
• Tracked referral submission during facilitation of prior authorization issuance.

• Submitted Prior authorizations for Medications
• Enrolled patients in free med and saving programs for affordable medicine.
• Piloted a new Program that supported medical billing of CGM products.
• Secured patient information and confidential medical records in compliance with HIPAA privacy rule standards to protect patient's privacy.
• Collected and entered patient demographic and insurance data into computer database to establish patient's medical record.
• Stayed calm under pressure to and successfully dealt with difficult situations.
• Obtained patient's insurance information and determined eligibility for benefits for specific services rendered
• Obtained patient's insurance information and determined eligibility for benefits for specific services rendered.
• Providing excellent customer service by promptly answering patient inquiries.
• Provided excellent customer service to patients and medical staff.
• Utilized knowledge of electronic medical record systems and medical terminology to perform diverse data entry tasks.
• Trained new staff on hospital processes and procedures.
• Engaged with patients to provide critical information.
• Delivered support to medical staff in completion of patient paperwork.

• Trained in Epic & Canvas EHR systems.
• Coordinated and packaged monthly medication pouching
• Submitted prior authorizations
• Answered incoming phone calls and addressed questions from customers and healthcare providers.
• Calculated dosage, filled prescriptions, and prepared prescription labels with absolute accuracy.
• Stocked, labeled, and inventoried medication to keep accurate records.
• Entered and processed patients' prescriptions into internal system.

• Senior Technician status/lead role under management.
• Resolved third-party billing, computer system and customer service issues.
• Assisted pharmacist by filling prescriptions for customers and responding to patient questions regarding prescription and medication-specific issues.
• Maintained proper drug storage procedures, registries, and records for controlled drugs.
• Collected co-payments or full payments from customers.
• Welcomed customers to pharmacy and answered questions relating to prescriptions and over-the-counter products.
• Helped pharmacist clear problematic prescriptions and address customer questions to keep pharmacy efficient.
• Prepared packaging and labels for prescriptions, verifying accuracy of dosage, side effects, interactions, and refill instructions.
• Managed opening and closing duties for pharmacy.
• Restocked pharmacy shelves with current merchandise to drive consistent peripheral sales.
• Ordered medicines daily to replenish stock and increase inventory in anticipation of need.
• Answered incoming phone calls and addressed questions from customers and healthcare providers.
• Calculated dosage, filled prescriptions, and prepared prescription labels with absolute accuracy.
• Stocked, labeled, and inventoried medication to keep accurate records.
• Entered and processed patients' prescriptions into internal system.