Summary
Overview
Work History
Education
Skills
Certification
Languages
Timeline
Generic

Yoalin Hernandez

Goodyear,AZ

Summary

Pharmacy Claims Auditor with an understanding in the research of claims, Identifying errors, and determining appropriate resolutions. Knowledge in the appropriate billing of claims and audit rules. Data-driven professional with exceptional skills in analyzing and assessing billing discrepancy to initiate corrective actions.

Overview

5
5
years of professional experience
1
1
Certification

Work History

Pharmacy Claims Auditor

CVS Caremark
09.2020 - Current
  • Make outreach to pharmacy's and obtain proper documentation to ensure claim accuracy.
  • In the event of an inaccurate claim submission, follow the appropriate Policies & Procedures to get claims resubmitted in a timely manner
  • Familiarity with pharmacy claim adjudication standards and procedures.
  • Improved claim processing efficiency by conducting thorough audits and identifying areas for improvement.
  • Reduced claim discrepancies by diligently reviewing and validating all submitted claims documentation.
  • Supported company growth by training new hires on proper claims audit procedures and guidelines.
  • Researched claims and incident information to deliver solutions and resolve problems.

Pharmacy Technician

CVS Health
05.2019 - 09.2020
  • Unpack, sort, count, and label incoming merchandise, including items requiring special handling or refrigeration
  • Coordinated verification and filling daily prescriptions in high-volume pharmacy environment
  • Resolved non-routine issues like third party billing, computer system and customer service issues
  • Solved customer problems in-person or over telephone by providing assistance with orders, navigating systems, and locating items
  • Verified patient data and billing information to discover and resolve erroneous bills due to system errors
  • Calculated dosage, fill prescriptions, and prepare prescription labels with accuracy.
  • Stocked, labeled, and inventoried medication to keep accurate records.
  • Enhanced pharmacy workflow by assisting pharmacists with medication dispensing, labeling, and packaging.

Education

A.A - General Studies

Maricopa Community Colleges - South Mountain Community College
Phoenix, AZ
05.2016

Skills

  • Pharmacy and customer records management
  • Updating Medication History
  • FDA Drug Safety Guidelines
  • Confidentiality and HIPAA
  • Inbound/outbound phone calls
  • Microsoft Office
  • Claims Processing
  • Documentation Review
  • Team Collaboration
  • Claims Auditing
  • Compliance and regulations

Certification

Certified Pharmacy Technician (CPhT), 12/2021

Languages

English
Spanish

Timeline

Pharmacy Claims Auditor

CVS Caremark
09.2020 - Current

Pharmacy Technician

CVS Health
05.2019 - 09.2020

A.A - General Studies

Maricopa Community Colleges - South Mountain Community College
Certified Pharmacy Technician (CPhT), 12/2021

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Yoalin Hernandez