Summary
Overview
Work History
Education
Skills
Timeline
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Ollen Williams

Rancho San Diego,CA

Summary

Detail-oriented medical/clinical professional with multiple years of diverse experience spanning pharmaceutical R&D and manufacturing document creation and review, medical and pharmaceutical authorizations. Proven ability to interpret and apply clinical and industry measures to streamline claims authorization & processing to resolve complex coverage issues. Brings strong working knowledge of clinical, medical, and claims review and determination methods. Quick to adapt to new systems, policies, and procedures in fast-paced environments.

Overview

15
15
years of professional experience

Work History

Infusion Pharmacy & Insurance Authorization

Medical Oncology
07.2021 - Current
  • Facilitated insurance prior authorizations and benefit investigations for high-cost oncology treatments
  • Reviewed patient medication records and reconciled histories to ensure accuracy and reduce claim rejections
  • Utilized and coordinated several software programs and portals for EMR review, patient medical/treatment authorization, billing and reconciliation
  • Prior claims investigation and review for program benefits audits and FWA review

Inpatient Pharmacy

UCSD Hospital
05.2017 - 09.2023
  • Reviewed orders dose calculations and compounded emergency department ICU and SICU medications for immediate patient need
  • Precise detailed review of MAR records and medication histories to ensure prompt and correct medication therapies
  • Excellent communication skills for interaction with management, staff, and other departments in relation to information flow and documentation
  • Ability to independently initiate, plan, and coordinate multiple projects simultaneously

Pharmacy Claims & Claims Service Coordinator

Southern Compounding
10.2010 - 05.2017
  • Understanding and application of mathematical concepts for calculations related to compensation and claims adjudication/closing of case files in workers compensation and commercial insurance files
  • Firm understanding of the insurance industry, its operation and regulations, related to claims review documentation, and patient medical/treatment authorization, billing and reconciliation
  • Ability to independently initiate, plan, and coordinate multiple projects simultaneously, while keeping attention to detail
  • Handled very heavy phones and electronic communication methods while also handling difficult calls and difficult situations

Education

Some College (No Degree) - General Education

Cuyamaca College
El Cajon, CA

Skills

  • Claims and authorizations: Highly skilled in medical authorization claims processing, benefits verification and insurance coordination Adept in investigation, analysis, review, and documentation of working files
  • Customer Service & Call Center Operations: Strong background in high stress/high-volume customer service environments Experienced and effective at handling managerial escalated calls and situations with tact and professionalism
  • Regulatory Compliance & Confidentiality: Thorough knowledge of HIPAA regulations and privacy laws, secure handling of sensitive information while maintaining strict compliance in all aspects of documentation and communication
  • Knowledge of medical terminology and procedures: Experienced in medical diagnosis and ICD9/10 coding, EMR medical and clinical history review, Coordination with multiple departments for the flow and exchange of file information Understanding of the connection between
  • Friendly, positive attitude
  • Teamwork and collaboration
  • Customer service
  • Problem-solving
  • Time management
  • Attention to detail
  • Flexible and adaptable
  • Dependable and responsible
  • Multitasking
  • Multitasking Abilities
  • Excellent communication
  • Critical thinking
  • Computer skills
  • Organizational skills
  • Calm under pressure
  • Active listening
  • Organization and time management
  • Decision-making
  • Problem resolution
  • Verbal communication

Timeline

Infusion Pharmacy & Insurance Authorization

Medical Oncology
07.2021 - Current

Inpatient Pharmacy

UCSD Hospital
05.2017 - 09.2023

Pharmacy Claims & Claims Service Coordinator

Southern Compounding
10.2010 - 05.2017

Some College (No Degree) - General Education

Cuyamaca College

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Ollen Williams