Taylour Lewis
Ocala,FL
Overview
2026
2026
years of professional experience
Work History
Pharmacy Technician
Prime Therapeutics LLC
Ocala, FL
2024 - Current
- Evaluated and authorized prior authorization requests for medications based on clinical criteria and pharmacy benefits.
- Maintained communication with prescribers, pharmacies, and members to gather information and resolve issues.
- Escalated complex requests requiring detailed clinical review to pharmacists or nurses on clinical team.
- Ensured compliance with company policies, client criteria, and applicable regulatory requirements.
- Met performance standards for quality, productivity, and schedule adherence.
- Processed prescriptions accurately using pharmacy software systems.
Customer Claims Representative
Everise
Ocala, Florida
2023 - 2024
- Managed high volume of inbound calls and inquiries to resolve issues and process requests.
- Provided comprehensive information regarding medical benefits and claims processing to healthcare providers.
- Troubleshot problems, processed claims, and addressed customer complaints efficiently.
- Assisted healthcare providers with prior authorizations, billing tasks, and resource navigation.
- Handled inquiries via phone, email, and chat to enhance client satisfaction.
- Guided providers in accessing vital resources including pharmacies and specialists.
- Looked up benefits to ensure accurate information delivery to clients.
- Resolved customer issues through effective communication and problem-solving techniques.
Provider Relations Representative
Streamline Imaging LLC
Ocala, Florida
2021 - 2023
- Processed workers compensation claims, referrals, and grievances within a 24- to 48-hour timeframe.
- Identified physical therapy, chiropractic, massage, and specialty service providers for adjusters.
- Negotiated single case agreements with out-of-network facilities to expand provider options.
- Maintained communication with adjusters regarding referrals and appointments through email and phone.
- Executed over 75 phone calls daily while managing more than 50 emails.
- Collaborated with internal teams to efficiently resolve provider-related issues.
- Supported contract negotiations with healthcare providers to secure favorable terms.
Senior Process Executive
Cognizant Technologies Solutions
Tampa, Florida
2016 - 2018
- Delivered benefits information including medical, dental, and vision coverage to members.
- Scheduled appointments for Medicare, Medicaid, and CHP insurance based on eligibility status.
- Ensured compliance with all HIPAA laws and PHI policies during member interactions.
- Documented customer interactions meticulously to enhance relationship quality.
- Collaborated with outside vendors to address inquiries and resolve issues efficiently.
- Processed claims and grievances in a timely manner.
- Provided detailed status updates on claims, explaining denial, approval, or pending reasons.
Education
Bachelor of Science - Business Administration And Management
Polk State College
Winter Haven, FLSkills
- Microsoft Office proficiency
- Pharmacy systems expertise
- Medicare and Medicaid familiarity
- CPT and ICD-10 coding
- Medical claims processing
- Workers' compensation claims handling
- Time management
- Authorization and referral management
- Multi-system operation skills
- Data analysis
- Healthcare regulations
- Problem-solving skills
- FDA and HIPAA compliance
Timeline
Pharmacy Technician
Prime Therapeutics LLC
2024 - Current
Customer Claims Representative
Everise
2023 - 2024
Provider Relations Representative
Streamline Imaging LLC
2021 - 2023
Senior Process Executive
Cognizant Technologies Solutions
2016 - 2018
Bachelor of Science - Business Administration And Management
Polk State College
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