Summary
Overview
Work History
Education
Skills
Certification
Languages
Timeline
Generic

Rikki Ramirez

Las Vegas,NV

Summary

Professional in healthcare administration with strong background in managing authorization processes. Adept at ensuring compliance, streamlining workflows, and mitigating risks. Consistent track record of fostering team collaboration and achieving results in dynamic environments. Skilled in navigating complex systems, prioritizing tasks, and maintaining high standards of accuracy and efficiency.

Overview

12
12
years of professional experience
1
1
Certification

Work History

Prior Authorization Specialist

Elevance Health
04.2025 - Current
  • Collaborated with physicians to obtain necessary clinical information for prior authorization submissions.
  • Maintained thorough knowledge of insurance plan requirements, facilitating accurate and timely completion of authorization forms.
  • Analyzed medical records and other documents to determine approval of requests for authorization.
  • Verified eligibility and compliance with authorization requirements for service providers.
  • Responded to inquiries from healthcare providers regarding prior authorization requests.
  • Reduced turnaround time for prior authorization requests by utilizing electronic submission methods.
  • Evaluated clinical criteria for approval or denial of services requiring pre-authorization.
  • Monitored pending cases closely, proactively following up on outstanding documentation needed for successful approval outcomes.
  • Achieved high success rate in obtaining authorizations by effectively demonstrating medical necessity through comprehensive documentation and clear communication with insurance companies.
  • Managed a high volume of incoming calls, maintaining professionalism while effectively addressing the needs of callers seeking assistance with prior authorizations.
  • Maintained organized records and up-to-date files for all completed and pending authorization requests, ensuring easy access during audits or reviews.

Government pharmacy benefits

SelectHealth
06.2023 - 02.2025
  • Provided customer service by actively listening to and addressing concerns in inbound and outbound calls
  • Completed tasks in a timely manner to ensure efficient service delivery
  • Educated members about medical benefits to enhance their understanding
  • Called pharmacies to process claims and ensure timely medication delivery
  • Assisted in problem-solving to address issues and provide solutions
  • Collaborated with team members to optimize workflow and enhance customer satisfaction
  • Skilled at working independently and collaboratively in a team environment.
  • Worked effectively in fast-paced environments.
  • Self-motivated, with a strong sense of personal responsibility.
  • Passionate about learning and committed to continual improvement.
  • Assisted with day-to-day operations, working efficiently and productively with all team members.

Pharmacy Technician

CVS Health
12.2017 - 06.2022
  • Calculated dosages, filled prescriptions, and accurately prepared prescription labels
  • Stocked, labeled, and inventoried medication to keep accurate records.
  • Enhanced pharmacy workflow by assisting pharmacists with medication dispensing, labeling, and packaging.
  • Solved customer problems in-person or over telephone by providing assistance with placing orders, navigating systems, and locating items.
  • Counted and labeled prescriptions with correct item and quantity.
  • Assisted in maintaining a clean and organized work environment, ensuring compliance with safety regulations.
  • Increased overall pharmacy productivity by restocking supplies, organizing shelves, and maintaining cleanliness according to standards.
  • Performed wide range of pharmacy operations with strong commitment to accuracy, efficiency and service quality.
  • Counted, labeled, and inventoried medications to maintain precise records
  • Assisted pharmacists in verifying prescriptions and ensuring medication accuracy
  • Maintained cleanliness and organization of pharmacy workspace
  • Provided excellent customer service and support to patients in need
  • Answered incoming phone calls and addressed questions from customers and healthcare providers.

Beauty Studio Coordinator

Sephora
09.2014 - 12.2017
  • Provided feedback to employees for coaching and development
  • Addressed employee and customer complaints to ensure satisfaction
  • Conducted performance appraisals for employees
  • Built and maintained clientele through exceptional service
  • Demonstrated professionalism and artistry in services provided
  • Resolved concerns and conflicts effectively

Guest Service Representative

Las Vegas Monorail Company
04.2013 - 09.2014
  • Responded to incoming guests, telephone calls, and email inquiries with efficiency and professionalism
  • Streamlined check-in process to decrease wait times and increase customer satisfaction
  • Assisted guests with check-ins, account inquiries, and any additional services needed
  • Investigated guest challenges and sources of dissatisfaction to offer timely resolution
  • Communicated problems regarding guest rooms to housekeeping services and maintenance personnel
  • Collected room deposits, fees, and payments
  • Provided information regarding hotel services and amenities
  • Collaborated with pharmacy staff to ensure efficient workflow and customer service

Education

Cosmetology -

Aveda
Las Vegas, NV
12.2012

High school diploma - undefined

Foot hill high school
Las Vegas, NV
06.2007

Skills

  • Customer service
  • Computer literacy
  • Time management
  • Communication skills
  • Guest services
  • Microsoft word
  • Documentation review
  • Leadership
  • Prior authorization process
  • Medical terminology

Certification

Pharmacy technician license

Languages

Spanish

Timeline

Prior Authorization Specialist

Elevance Health
04.2025 - Current

Government pharmacy benefits

SelectHealth
06.2023 - 02.2025

Pharmacy Technician

CVS Health
12.2017 - 06.2022

Beauty Studio Coordinator

Sephora
09.2014 - 12.2017

Guest Service Representative

Las Vegas Monorail Company
04.2013 - 09.2014

High school diploma - undefined

Foot hill high school

Cosmetology -

Aveda

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