Susan Lake

• Verified prescription information prior to entry in pharmacy computer system.
• Trained new employees on pharmacy procedures, policies, and safety protocols to ensure consistent quality across the team.
• Safeguarded patient privacy by maintaining strict adherence to HIPAA regulations during all customer interactions.
• Prepared prescription labels accurately, reducing the risk of medication errors for patients.
• Maintained up-to-date knowledge of pharmaceutical products, enhancing quality of customer advisories.
• Improved customer trust with confidential handling of sensitive health information.
• Processed prescription orders to ensure timely fulfillment for customer satisfaction.

Verified patient information to correctly dispense medications.

• Verified eligibility and compliance with authorization requirements for service providers.
• Maintained thorough knowledge of insurance plan requirements, facilitating accurate and timely completion of authorization forms.
• Analyzed medical records and other documents to determine approval of requests for authorization.
• Reached out to insurance carriers to obtain prior authorization for testing and procedures.
• Responded to inquiries from healthcare providers regarding prior authorization requests.
• Reduced turnaround time for prior authorization requests by utilizing electronic submission methods.
• Collaborated with physicians to obtain necessary clinical information for prior authorization submissions.
• Achieved high success rate in obtaining authorizations by effectively demonstrating medical necessity through comprehensive documentation and clear communication with insurance companies.
• Monitored pending cases closely, proactively following up on outstanding documentation needed for successful approval outcomes.
• Obtained and logged accurate patient insurance and demographic information for use by insurance providers and medical personnel.
• Reviewed appeals for prior authorization requests and communicated with payers to resolve issues.
• Researched denied claims and contacted insurance companies to resolve these issues.
• Managed a high volume of incoming calls, maintaining professionalism while effectively addressing the needs of callers seeking assistance with prior authorizations.
• Contributed to a high level of customer service by quickly addressing questions or concerns from patients regarding their coverage or denials.
• Prepared and distributed denial letters, detailing reasons for denial and possible appeal measures.
• Enhanced communication between healthcare providers and insurance companies, ensuring prompt resolution of issues related to prior authorizations.
• Provided prior authorization support for physicians, healthcare providers and patients in accordance with payer guidelines.
• Continually updated knowledge on industry developments, ensuring adherence to best practices and relevant regulatory changes impacting the prior authorization process.
• Supported healthcare providers by offering guidance on alternative treatment options when initial requests were denied.

Obtain pre-certifications and appeals as needed

Ensure all insurance criteria have been met

Scheduled capsule endoscopies

Ensure patient understanding and compliance of preparation and capsule submission processes