Sarah Taveira, CPht

Specialty Pharmacy Integrator - Remote Position - Current

• Directly communicate with insurance companies to facilitate the approval of medications
• Navigate pharmacy operating systems to input data, perform adjudication on test claims, and prepare action plans for follow-up
• Effectively communicate across databases, electronic medical records, and emails to document patient concerns, prior authorization status, and financial assistance needs
• Review prescriptions with doctors' offices to ensure the optimal care of patients
• Keep complete and accurate records of patient communications
• Assist patients in the management of their pharmacy insurance claims
• Work closely with pharmacists and pharmacy liaisons to provide an integrated approach to quality patient care
• Communicate directly with patients over the phone to assist them in all aspects of medication compliance
• Research and investigate information to enable strategic decision-making by others.
• Manage, organize, and update relevant data using database applications

Pharmacy Benefit Manager (PBM) - Remote Position - 1 yr 8 mos

• Process prior authorization requests for Medicaid programs in New York, South Florida, Louisiana, Minnesota, Michigan, and Nevada.
• Assist with clinical support, handling medical documents, coordinating patient care, and collaborating with healthcare teams to ensure continuity of care.
• Exercised patience and empathy when interacting with complex patients, and collaborating with hospital staff under high-pressure conditions.
• Adapted to changes in policies, regulations, and procedures, maintaining flexibility, and a strong work ethic in a dynamic environment.
• Worked through billing rejections for pharmacies, often taking calls for our Pharmacy Helpdesk, and input overrides when necessary.
• Utilize CoverMyMeds (CMM) and FirstTrax to review, approve, and deny (or close as informational, depending on the state) medication requests, ensuring all actions comply with state and federal regulations.
• Collaborate with healthcare providers to gather necessary documentation and provide timely responses to prior authorization requests.
• Offer customer support to doctors, medical staff, pharmacies, and patients, resolving issues related to prescription claims, medication access, and pharmacy services.

High Volume Retail - Traditional On-site - 8 months

• Provided multi-tasking support in a fast-paced environment.
• Handled over-the-phone and in-person patient care while maintaining high customer service standards.
• Conducted problem-solving for billing rejections, prescription errors, and administrative challenges.
• Filled prescriptions accurately, working as part of a team to stock, clean, check, and receive medications and supplies in a busy pharmacy environment.
• Performed opening and closing duties, including cash deposits, register management, and facility cleaning, maintaining a well-organized work environment.
• Point of Sale Pharmacy Software: CONNEXUS.

Traditional On-site - Closed-Door Delivery Pharmacy - 1 Year.

• Managed complex patient cases (HIV, transplant, hepatitis C, cancer) with specialized care and attention.
• Coordinated monthly medication shipments to ensure timely, accurate delivery.
• Resolved billing rejections and errors, ensuring smooth claims processing.
• Filled prescriptions accurately and efficiently, and assisted in stocking, cleaning, and receiving medications.
• Prepared medications for shipment, including creating FedEx labels, and ensuring proper handling.
• Provided multi-tasking support in a fast-paced environment, balancing patient care, administrative duties, and team collaboration.
• Assisted with clinical support, including managing medical documents, and patient care coordination.
• Handled prior authorizations for high-cost specialty medications, collaborating with patients and healthcare providers.
• Managed electronic medical records (EMR), ensuring confidentiality and accuracy.
• Proficient in INTERCOM-PLUS (Pharmacy POS), Assembia1 (used for monthly MTM documentation and scheduling), and Microsoft Office Suite (Word, Outlook, Teams).

Hospitals & Clinics - Remote Position - 3 years, 4 months.

• Provided multi-tasking support in a fast-paced environment, balancing patient care, administrative duties, and team collaboration.
• Provided excellent over-the-phone support to patients and staff.
• Initiated prior authorizations for procedures, appointments, and medications, ensuring compliance with protocols, and timely approvals.
• Maintained a high typing speed and accuracy, ensuring efficient documentation of patient and medication information.
• Exercised patience and empathy when working with complex patients, and coordinating with overworked hospital staff.
• Scheduled appointments and procedures, ensuring efficient patient care, and proper coordination with medical teams.
• Managed and processed electronic medical records (EMR), ensuring confidentiality and accuracy of patient information through EPIC Hyperspace.
• Continuously enhanced skills through ongoing training in medical knowledge, call flows, and triage.
• I worked for the University's COVID-19 Hotline, as well.