Sarah Powers Email & Phone Number

Taunton, Massachusetts, United States

-Manages and identifies a portfolio of rejected pharmacy claims to ensure maximum payer reimbursement and timely billing to eliminate financial risks-Researches, analyzes and appropriately resolves rejected claims by working with national Medicare D plans, third party insurance companies and all state Medicaid plans to ensure maximum payer reimbursement adhering to critical deadlines-Ensures approval of claims by performing appropriate edits and/or reversals to ensure maximum payer reimbursement-Monitors and resolves at risk revenue associated with payer set up, billing, rebilling and reversal processes-Works as a team to identify, document, communicate and resolve payer/billing trends and issues-Reviews and works to convert billing exception reports to ensure claims are billed to accurate financial plans-Prepares and maintains reports and records for processing-Performs other tasks as assigned

Attleboro, Massachusetts, United States

● Prepares sterile products including hazardous, chemotherapeutic and study medications in accordance with Federal USP <797> standards.● Monitors medication order reports and assigns medications to automated dispensingGastroenterology Specialty Pharmacy Liaison ● Understands product and payer reimbursement landscape and prior authorization guidelines and processes.● Collects and reviews all data needed for prior authorization approvals.● Resolves insurance related issues, including prior authorizations and financial assistance.● Provides exceptional customer service to internal and external customers● Coordinates services with providers, specialty pharmacies to improve turnaround time for patients.● Communicates directly with patients to assist them in the awareness of their medications and coordinate teaching visits. Serves as the direct patient and provider contact for pharmacy benefit information● Manage multiple strategic initiatives simultaneously and prioritize where necessary and independently and effectively resolves complex accounts, and determine the methods and procedures on new or special assignments with minimal supervision.

Southborough, Massachusetts, United States

ob Responsibilities (but not limited to): [PHARM Core 25 (d)]• Provide support for Clinical Programs to create and maintain prior authorization guidelines for clinical product offerings.• Gather all required information for the PA review.• Intake Prior Authorization requests from the phone and fax queue.• Review and approve physician inquiries for pre-authorization and medical necessity requests based on established pharmacy guidelines and contract criteria.• Conducts root-cause analysis for any issues associated with a PA request.• Assists with compiling statistical data, reporting and analyses to demonstrate PA clinical, financial, and operational effectiveness and quality.• Provides support for internal and external audits and surveys.• Maintain accurate and complete documentation of all inquiries for continuous improvement.• Follow all internal Policies & Procedures to ensure consistency, accuracy, and operational effectiveness.• Supports Fraud, Waste and Abuse program system oversight and communicates any suspected fraud discovered.• Follows all state and federal regulations applicable to PBM operations and utilization management.• Keep up to date with industry trends and regulatory changes in the pharmacy industry.• Attends required training as needed.• Attends required meetings as needed.• Work collaboratively with other teams to resolve issues and improve operational processes.• Maintains quality service by enforcing quality and stakeholder service standards, analyzing, and resolving quality and stakeholder (member, client, pharmacy) service problems and recommending system improvements.• Other responsibilities as required• Have a thorough understanding of, and perform in compliance with, the current PBM v2.2 URACstandards applicable to the position

Boston, Massachusetts, United States

Prepares sterile products including hazardous, chemotherapeutic and study medications in accordance with Federal USP <797> standards. Monitors medication order reports and assigns medications to automated dispensing cabinets. Reviews current inventory list for automated dispensing cabinets to determine medications that should be removed based on knowledge of unit based practice site and the types of medications used on each site. Delivers controlled substances to automated dispensing cabinets in compliance with all DEA and DPH regulations. Monitors expiration dates of controlled substances automated dispensing cabinets. Acts as witness for Pharmacists to destroy or secure expired controlled substance and narcotic waste.Restocks floor stock/automated dispensing cabinets. Enters charges and credits to patients for the medications sent on the daily IV delivery and cartfill to insure an accurate bill. Refills and exchanges code boxes and emergency medications to nursing units and ancillary areas. Monitors expiration dates of code boxes and emergency kits in the pharmacy. Delivers IV medications to the appropriate location. Recycles IVs when appropriate. Maintains records pertaining to IV admixtures, cleanliness and restocks admixture area as well as completes all appropriate QA.Reconstitutes powders, ability and knowledge to calculate volume and dosage, prepare admixture, and check admixture for clarity and presence of particulate matter label and date admixture correctly.

Boston, Massachusetts

1. Understands product and payer reimbursement landscape and prior authorization guidelines and processes.(essential)2. Collects and reviews all data needed for prior authorization approvals. (essential)3. Resolves insurance related issues, including prior authorizations (PAs), and assist patients with variousforms of financial assistance. (essential)4. Provides exceptional customer service to internal and external customers; resolves any customer requestsin a timely and accurate manner; escalates complaints accordingly; maintains frequent phone contact withpatient, provider and pharmacy staff; and clarifies prescription orders with pharmacist and/or clinician asappropriate (essential)5. Serves as the direct patient and provider contact for pharmacy benefit information, clinical and programinformation. (essential)6. Coordinates services with providers, specialty pharmacies and national account managers to improveturnaround time for patients. (essential)7. Communicates directly with patients to assist them in the awareness of their medications and coordinateteaching visits. (essential)8. Manage multiple strategic initiatives simultaneously and reprioritize where necessary and independentlyand effectively resolves complex accounts, and determine methods and procedures on new or specialassignments with minimal supervision. (essential)9. Networks with key contacts outside own area of expertise. (essential)10. Provides training and support to inter-departmental associates. (essential)

Milford, Massachusetts

Part of a team that travels to CVS Caremark Specialty pharmacies to train and support the staff as the site converts to a new pharmacy computer system. My specific responsibilities include training and teaching pharmacy technicians the basic functionality including resolving Insurance issues, and communication with other staff. Adapt to strategy and style to relate to different types of personalities and regional differences to ensure that each employee is comfortable using the system. Adjusting clients billing information for insurance. solve rejection for all pharmacy ECS claims, Requesting prior authorization, verifying active coverage and verifying benefits.High call volume with speed to answer 15 second.

Avon, Massachusetts

Run the script through the insurance company. Fix any submission problems the may come up in the insurance. Pick the medications to habe the pharmacist do thw last check and package thw med to be shipped

Taunton, Massachusetts

Assisted in the IV clean room. Stocked medication cart and crash carts. Accurately pulled medications as needed.

Certification, Pharmacy Technician/Assistant

Activities and Societies: Prepare prescription for medication. Providing patients with information on drugs. Labeling and packaging.

Associate'S Degree, Finance And Financial Management Services