Rosmine Pires-Garcia
Henderson,NV
Summary
Seeking to expand my knowledge within a growing company, to maintain a career in the pharmacy industry by utilizing my current experience to take on new challenging roles and becoming more of an asset to other areas of the business.
Overview
9
9
years of professional experience
1
1
Certification
Work History
Associate Business Process Analyst
OptumRx
11.2024 - Current
Business Operations Specialist
OptumRx
09.2021 - 11.2024
- Utilize Microsoft Excel daily to report data analysis for the Prior Authorization Performance & Data Insights team.
- Created various documents using Microsoft Office applications such as Word, Excel and PowerPoint.
- Created many detailed process flow diagrams using Microsoft Visio to create clear and concise diagrams for complex processes.
- Leveraged Microsoft Power Automate to streamline workflows and increase productivity.
- Learned how to create SharePoint sites to improve team collaboration and documentation productivity.
- Developed presentations using PowerPoint software for team engagement.
- Gained experience in hosting team meetings.
Business Segment Liaison
OptumRx
Las Vegas, NV
03.2018 - 09.2021
- Assist with the ordering of Software and Hardware
- On-boarding new employees
- Inventory Management
- Assist leadership in ensuring all agent's access maintained active
- Setting up the equipment for all employees
- In charge of maintaining sites spreadsheets, charts, and filtered data (Microsoft Excel)
- Maintaining the proper care of our facility
- In charge of the ePass system for our site - badge access
- Site mail and package distributer
- Assisted leadership in receptionist style check- ins for interviewers
- In charge of invoice processing, submitting, and ensuring they are paid
Senior Pharmacy Prior Authorization/Appeals Technician
OptumRx
Las Vegas, NV
02.2017 - 09.2021
- Process member prior authorizations for ALL Medicaid and high touch clients
- Navigate across multiple computer systems to respond to questions and to provide specific medication details and clinical information
- Outreach team for high touch clients - Educate members, guardians, providers, pharmacy staff on procedures to avoid compliance risk
- Manages to meet NCQA and URAC compliance
- Background in improving work processes that increase customer satisfaction
- Advanced in processing in RxAuth, RxClaims, PAS, Navigator systems
- Member of the high touch QualChoice, BCBSSC enhanced outreach team
Service Now Prior Authorization Operations Specialist
OptumRx
Las Vegas, NV
02.2019 - 09.2021
- Assist the public sector accounts such as FFS Nevada, Arizona, Georgia, South Dakota Medicaid in not only the Prior Authorization production requests but also worked on any ServiceNow tasks such as misroutes, investigated errors and provided solutions
- Assist high touch Client Services with questions related to prior authorizations
- Responds to escalated prior authorization and appeal calls and/or issues
- Take actions to direct, analysis and solutions of problems; escalate when needed
- Ensure developed solutions match Client requirements
- Work with Account Management teams to ensure all implementation items are tracked, documented and closed, in agreement with the client intent
- Independently contributed the ability to multi-task and work with leaders to ensure client satisfaction
- Ensured timely, and quality implementation tracking, reporting and communication strategies are utilized using established policies & procedures
Prior Authorization Technician
Expert Global Solutions (Alorica)
Henderson, NV
08.2015 - 06.2016
- Processed member prior authorizations through multiple computer systems ensuring the accuracy of all data and updating
- Review rejected claims and conduct necessary third-party authorization requests
- Educate members / guardians, providers, pharmacies) staff on procedures to avoid compliance risk
- Receive incoming calls from members or providers; conduct outgoing calls as needed to provide follow - up or consultation such as prior authorization requirements, appeals, etc
Education
Pharmacy Technician License -
Milan Institute
Las Vegas, NV05.2015
Diploma -
Odyssey Charter High School
01.2013
Skills
- Proficiency with computer applications such as Microsoft Excel, Power Automate, Word, Visio, and PowerPoint
- Knowledge of Medicaid and pharmacy law
- Experienced in creating Excel macro tools
- Knowledge of AS400
- Knowledge of RxClaims
- Knowledge of RxAuth
- Knowledge of PAS
- Knowledge of ServiceNow
- Knowledge of Navigator
- Knowledge of RxHD
- Extensive experience in the PBM industry
- Team collaboration
Certification
- Certified Pharmacy Technician, PT16575, 10/31/26
- First Aid/CPR/AED Certified, Current
Timeline
Associate Business Process Analyst
OptumRx
11.2024 - Current
Business Operations Specialist
OptumRx
09.2021 - 11.2024
Service Now Prior Authorization Operations Specialist
OptumRx
02.2019 - 09.2021
Business Segment Liaison
OptumRx
03.2018 - 09.2021
Senior Pharmacy Prior Authorization/Appeals Technician
OptumRx
02.2017 - 09.2021
Prior Authorization Technician
Expert Global Solutions (Alorica)
08.2015 - 06.2016
Pharmacy Technician License -
Milan Institute
Diploma -
Odyssey Charter High School
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