Ruth Lespinasse
Orlando,FL
Summary
Focused patient care professional manner and offers over 5 years of comprehensive experience in preparing accurate documentation in patient records. High achiever, is willing to go above and beyond required tasks. Recognized by patients for delivering five-star patient care. Driven Pharmacy Technician with proven track record and success in building strong relationships with patients and clients. Detail-oriented Prior authorization liaison with a commitment to maintaining high-quality assurance and control standards when filling prescriptions.
Overview
5
5
years of professional experience
Work History
Prior Authorization Coordinator
BIOPLUS SPECIALTY
10.2022 - Current
- Verified eligibility and compliance with authorization requirements for service providers.
- Fielded telephone inquiries on authorization details from plan members and medical staff.
- Tracked referral submission during facilitation of prior authorization issuance.
- Prepared and distributed denial letters, detailing reasons for denial and possible appeal measures.
- Work side by side with all insurance plan types, Commercial, Medicare A, B and D.
- Input all patient data regarding claims and prior authorizations into system accurately.
PATIENT CARE COODINATOR LEAD
CENTENE CORPERATION
06.2019 - 10.2022
- Managed quality assurance practices for each employee on my team.
- Preformed coaching to each employee for better call quality.
- Managed over 50 escalated outbound calls pleasantly and timely manner.
- Communicating with patients about their account status and scheduling deliveries.
- De-escalate challenging calls for upset patients and doctor's office.
- Responding to escalated emails and completing daily tasks when assigned.
- Managed and motivated employees to be productive and engaged in work.
Education
CERTIFICATE Pharmaceutical Technology - Pharmaceutical Sciences
Technical Education Center
Osceola Kissimmee, FL08.2009
High School Diploma -
Poinciana High School
Kissimmee, FL05.2007
Skills
- 9 months of education of pharmaceutical technology
- 3 months of internship at Walgreens Rx
- Excellent customer service to patients, both in person and via telephone
- Medical Terminology
- Benefits Verifications
- Quality Assurance
- Team Lead
- Skilled in pharmacy calculations of pills and inventory
- ICD-10 knowledge
- Electronic claims processing
- Health Insurance Plan Knowledge
- HIPAA Compliance Trained
- Prescription Refills
- Data entry
Timeline
Prior Authorization Coordinator
BIOPLUS SPECIALTY
10.2022 - Current
PATIENT CARE COODINATOR LEAD
CENTENE CORPERATION
06.2019 - 10.2022
CERTIFICATE Pharmaceutical Technology - Pharmaceutical Sciences
Technical Education Center
High School Diploma -
Poinciana High School
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