Robyn James
Wauwatosa,WI
Summary
Certified Pharmacy Technician with over 20 years of experience. Long Term Care Pharmacy and PBM experience. Organized and dependable candidate successful at managing multiple priorities with a positive attitude. Willingness to take on added responsibilities to meet team goals.
Overview
21
21
years of professional experience
1
1
Certification
Work History
Part D and Appeal Coordinator
iCare Independent Health Plan
01.2020 - Current
- Assists members and Pharmacies with medication claim issues
- Gives members information on their prescription benefits via telephone
- Reviews denied claims daily to ensure proper claim submission for member’s medications
- Submits Prior Authorizations for members to Med-Impact
- Submits appeals for medications that are denied by medication processor for Part D Redetermination
- Assists Data Analytics department with finding new NDCs for covered medications
- Assists with medication adherence
- Monitors ESRD (End Stage Renal Disease) and Hospice Claims for proper submission.
- Gathers and organizes materials to support operations.
- Tracks records, files documents and maintains communication between clients to manage office activities.
- Uses job-related software to draft and finalize written correspondence and documentation.
- Resolves issues through active listening and open-ended questioning, escalating major problems to manager.
- Improves customer satisfaction scores through application of superior conflict resolution and problem-solving skills.
Inpatient Certified Pharmacy Technician
Advocate Aurora West Allis Medical Center
11.2019 - 04.2020
- Performed various pharmacy operational activities with strong commitment to accuracy, efficiency, and service quality.
- Stocked, labeled, and inventoried medication to keep accurate records.
- Delivered medications to different floors and departments of hospital
- Restocked Pyxis machines with appropriate medications and supplies
Lead Certified Pharmacy Technician
PHOENIX PHARMACY
01.2007 - 11.2019
- Filled prescriptions in vials or blister packages
- Contacted insurance companies to solve problems for patients whether it is for prior authorizations or retro-active claims
- Billed monthly medication cycles through Medicare Part D and Medicaid for Wisconsin, Illinois, Indiana, New Jersey, North Carolina and South Carolina members
- Packaged and shipped prescriptions to multiple states
- Training of other technicians and assisted in training new pharmacists on computer systems
- Retro-active billing for client accounts
- Assisted Accounts Receivable Specialist with the posting of individual claim posting.
- Consulted with insurance company representatives to complete claims processing, resolve concerns, and reconcile payments.
- Stocked, labeled, and inventoried medication to keep accurate records.
- Supervised pharmacy technicians and coordinated day-to-day assignments.
- Communicated with prescribers to verify medication dosages, refill authorizations, and patient information.
- Answered incoming phone calls and addressed questions from customers and healthcare providers.
- Reviewed and verified customer information and insurance provider information.
- Set up and modified patient profiles in QS1 to include current information such as medications and insurance details.
- Restocked pharmacy shelves with current merchandise to drive consistent peripheral sales.
- Ordered medicines daily to replenish stock and increase inventory in anticipation of need.
- Calculated dosage, filled prescriptions, and prepared prescription labels with absolute racy.
- Monitored ordering of pharmacy medication stock to maintain streamlined inventory and low overhead.
Certified Pharmacy Technician
CVS PHARMACY, ( Formerly Osco Drug)
04.2002 - 01.2007
- Processed prescriptions via computer
- Received and processed refill requests over the phone
- Filled prescriptions
- Contacted insurance companies when necessary to solve problems for patients.
Education
Georgia Southern University
Statesboro, GA2000
Carl Harrison High School
Kennesaw, GA06.1999
Skills
- Customer Service
- Microsoft Excel
- Microsoft Word
- Microsoft Office
- Data Entry (Alpha and Numerical)
- Prescription Claim Billing
- Part D Determination and Redetermination
- Medicare and Medicaid Billing
- Correspondence and Reports
- Problem Resolution
- Work Planning and Prioritization
Certification
- CPhT - Certified Pharmacy Technician
Timeline
Part D and Appeal Coordinator
iCare Independent Health Plan
01.2020 - Current
Inpatient Certified Pharmacy Technician
Advocate Aurora West Allis Medical Center
11.2019 - 04.2020
Lead Certified Pharmacy Technician
PHOENIX PHARMACY
01.2007 - 11.2019
Certified Pharmacy Technician
CVS PHARMACY, ( Formerly Osco Drug)
04.2002 - 01.2007
Georgia Southern University
Carl Harrison High School
- CPhT - Certified Pharmacy Technician
Similar Profiles
ROBYN JAMESROBYN JAMES
Medication Access Specialist 1 at Froedtert HealthMedication Access Specialist 1 at Froedtert Health
Mandi BredemannMandi Bredemann
Quality Compliance Nurse Professional at Independent Care Health Plan (iCare), a Humana IncQuality Compliance Nurse Professional at Independent Care Health Plan (iCare), a Humana Inc
Leigh G. HaydenLeigh G. Hayden
Associate Director, Provider Contracting at Independent Care Health Plan (iCare), HumanaAssociate Director, Provider Contracting at Independent Care Health Plan (iCare), Humana