ROBYN JAMES
Wauwatosa
Summary
Professional with experience in facilitating access and support services. Known for strong collaborative skills and ability to adapt to changing needs, ensuring reliable and effective outcomes. Skilled in communication, problem-solving, and customer service. Valued for integrity, dependability, and results-driven mindset.
Overview
23
23
years of professional experience
1
1
Certification
Work History
Medication Access Specialist 1
Froedtert Health
02.2024 - Current
- Submission of Prior Authorizations via electronic ePA, Forward Health Portal or CoverMyMeds
- Calling insurance plans to check status of previously submitted prior authorizations or appeals
- Answering calls from insurance plans, clinics or patients
- Test Billing of prescriptions using Epic Ambulatory
- Sending referrals to Patient Assistance Team for Prescription Assistance Programs
- Assists with training of newly hired Medication Access Specialists
- Contributed to a positive work environment by actively participating in team meetings, sharing best practices, and providing constructive feedback when necessary.
- Leveraged knowledge of various software platforms to optimize the management of patient information and streamline daily tasks.
Part D Prior Authorization and Appeal Coordinator
iCare Independent Health Plan
01.2020 - 01.2024
- 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
- Assists with training of newly hired medication Access Specialists
- 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
BROADSTEP PHARMACY (formerly 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 accuracy
- Monitored ordering of pharmacy medication stock to maintain streamlined inventory and low overhead
Certified Pharmacy Technician
CVS PHARMACY
04.2002 - 01.2007
- Company Overview: ( Formerly Osco Drug)
- Processed prescriptions via computer
- ( Formerly Osco Drug)
Education
Georgia Southern University
Statesboro, GA12.2000
High school or equivalent -
Carl Harrison High School
Kennesaw, GA06.1999
Skills
- Customer Service
- Microsoft Word
- Microsoft Excel
- Microsoft Office
- Data Entry (Alpha and Numerical)
- Prescription Claim Billing
- Commercial and Part D Coverage Determination and Redetermination
- Medicare and Medicaid Billing
- Correspondence and Reports
- Problem Resolution
- Work Planning and Prioritizations
- Knowledge of Epic Willow Hyperspace and Ambulatory
- Customer support
- Security protocols
Certification
Nationally Certified Pharmacy Technician (Pharmacy Technician Certification Board)
2006-Current
Timeline
Medication Access Specialist 1
Froedtert Health
02.2024 - Current
Part D Prior Authorization and Appeal Coordinator
iCare Independent Health Plan
01.2020 - 01.2024
Inpatient Certified Pharmacy Technician
Advocate Aurora West Allis Medical Center
11.2019 - 04.2020
Lead Certified Pharmacy Technician
BROADSTEP PHARMACY (formerly PHOENIX PHARMACY)
01.2007 - 11.2019
Certified Pharmacy Technician
CVS PHARMACY
04.2002 - 01.2007
Nationally Certified Pharmacy Technician (Pharmacy Technician Certification Board)
2006-Current
Georgia Southern University
High school or equivalent -
Carl Harrison High School
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