Oversaw Medicaid and Health Insurance Marketplace coverage determinations using Prism, RxClaim, and RxAdvance. Medicaid prior authorizations include Louisiana, California, Washington, Oregon, and Indiana. Experience with commercial California health plan coverage determinations. Communicated with prescriber’s offices and members to resolve coverage determinations entering prior authorizations into RxClaim and RxAdvance. Resolved prior authorization issues ensuring timely… Show more Oversaw Medicaid and Health Insurance Marketplace coverage determinations using Prism, RxClaim, and RxAdvance. Medicaid prior authorizations include Louisiana, California, Washington, Oregon, and Indiana. Experience with commercial California health plan coverage determinations. Communicated with prescriber’s offices and members to resolve coverage determinations entering prior authorizations into RxClaim and RxAdvance. Resolved prior authorization issues ensuring timely resolution of issues and increasing overall customer satisfaction. Show less

Oversaw Medicare Part D coverage determinations with Medicare and Dual Demo Medicare-Medicaid clients using PaHub and Argus plus Prism and RxClaim. Medicare prior authorizations including Texas, and Ohio.

Managed Medicare Part D coverage determinations in CAS and MedHOK including EGWP clients. Entered overrides and ran test claims in RxClaim and PeopleSafe ensuring timely resolution of issues. Communicated with prescriber’s offices and members to resolve coverage determinations. Audited technician prior authorization reviews.

Activities included preparing and dispensing prescription medications, transferring prescriptions to and from other pharmacies, receiving verbal prescriptions from prescribers, counseling patients about proper use of their prescription and nonprescription medications, and assessing and recommending nonprescription medications and devices.

Responsibilities included processing prescription orders, maintaining inventory, processing insurance claims, compounding prescription orders, and cashier duties. Award for accurate entry of prescriptions (top five in district).