JENNIFER WON
Chino Hills
Summary
Results-driven management professional with proven ability to lead teams to success. Strong focus on team collaboration, operational efficiency, and achieving measurable outcomes. Adept at strategic planning, process improvement, and fostering culture of accountability and excellence. Known for adaptability and consistently meeting changing organizational needs.
Overview
12
12
years of professional experience
1
1
Certification
Work History
Prior Authorization Manager/Appeals Specialist
Sorrento Specialty Pharmacy
01.2024 - Current
- Submitted Prior Authorizations for IVIG, Rheumatology, Oncology, Neurology, Dermatology, Nephrology, Gastroenterology, and Allergy and Immunology
- Submitted clinical appeals and assisted in peer to peer reviews
- Assisted in copay assistance and manufacture free drugs
- Managed and motivated employees to be productive and engaged in work.
- Accomplished multiple tasks within established timeframes.
- Maintained professional, organized, and safe environment for employees and patrons.
- Enhanced customer satisfaction by resolving disputes promptly, maintaining open lines of communication, and ensuring high-quality service delivery.
- Maximized performance by monitoring daily activities and mentoring team members.
- Cross-trained existing employees to maximize team agility and performance.
- Developed a strong company culture focused on employee engagement, collaboration, and continuous learning opportunities.
- Assisted providers with writing of clinical appeals
- Assisted providers with peer to peer review
- Assisted provider with understanding denial letter
Prior Authorization/Prior Authorization Specialist/Appeals Specialist
Whole Health Pharmacy
08.2019 - 01.2024
- Collaborated with physicians to obtain necessary clinical information for prior authorization submissions.
- 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.
- Verified eligibility and compliance with authorization requirements for service providers.
- Reached out to insurance carriers to obtain prior authorization for testing and procedures.
- Responded to inquiries from healthcare providers regarding prior authorization requests.
- Evaluated clinical criteria for approval or denial of services requiring pre-authorization.
- Reduced turnaround time for prior authorization requests by utilizing electronic submission methods.
- 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.
- Provided training to new staff members on the intricacies of various insurance plans and their specific prior authorization requirements.
- Input all patient data regarding claims and prior authorizations into system accurately.
- Obtained and logged accurate patient insurance and demographic information for use by insurance providers and medical personnel.
- Tracked referral submission during facilitation of prior authorization issuance.
- 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.
- Fielded telephone inquiries on authorization details from plan members and medical staff.
- Maintained organized records and up-to-date files for all completed and pending authorization requests, ensuring easy access during audits or reviews.
- 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.
- Supported team members by providing guidance on complex cases requiring detailed understanding of medical necessity criteria.
- Coordinated with billing department to resolve discrepancies related to denied claims due to incomplete or incorrect prior authorizations.
- 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.
- Improved patient satisfaction with timely and accurate processing of prior authorizations for medications and procedures.
- Developed and maintained productive working relationships with healthcare providers.
- Participated in cross-functional initiatives to improve overall efficiency and effectiveness of the prior authorization process for all involved parties.
- Identified trends in denials through data analysis, adapting strategies accordingly for improved success rates in obtaining approvals.
- Streamlined prior authorization processes by implementing efficient tracking systems.
- Improved patient outcomes by expediting authorization process for urgent and life-saving treatments.
- Supported healthcare providers by offering guidance on alternative treatment options when initial requests were denied.
- Developed comprehensive database of insurance requirements and medication coverage to streamline prior authorization process.
- Collaborated with insurance companies to clarify coverage details and expedite review of complex cases.
- Assisted in development of educational materials for patients and providers about prior authorization process.
- Participated in quality improvement initiatives aimed at reducing errors and enhancing patient satisfaction with authorization process.
- Increased approval rates for necessary medical procedures by providing detailed justifications and patient history during review process.
- Analyzed trends in denied requests to identify opportunities for process improvement and training.
- Reduced turnaround time for prior authorization decisions by implementing more efficient review process.
- Streamlined submission of prior authorization requests, leading to faster patient access to needed treatments.
- Contributed to policy updates by providing feedback on common challenges encountered during authorization process.
- Advocated for patients by negotiating with insurance providers to cover necessary treatments not initially authorized.
- Fostered positive relationships with healthcare providers by ensuring transparent communication throughout authorization process.
- Implemented tracking system for prior authorization requests to monitor progress and identify bottlenecks.
- Conducted thorough reviews of medical documentation to ensure compliance with payer policies and patient care standards.
- Enhanced efficiency in processing prior authorization requests by streamlining documentation procedures.
- Facilitated cross-departmental training sessions to enhance understanding of prior authorization criteria and procedures.
- Coordinated with pharmacy staff to ensure timely dispensing of medications following authorization approval.
- Maintained up-to-date knowledge of changing healthcare regulations and insurance policies to ensure accurate processing of requests.
- Improved provider satisfaction with timely communications regarding authorization status updates.
- Reviewed applications for different aid programs and determined which qualification criteria for individuals.
- Communicated with people from various cultures and backgrounds on application process.
- Interviewed applicants and explained scope of different available benefits.
- Assisted clients with completion of applications and paperwork.
- Followed guidelines when reviewing applicant data to determine eligibility for economic assistance.
Prior Authorization Pharmacy Technician
Quality Home Infusions
04.2018 - 08.2019
- Promoted a safe environment for patients through strict adherence to state regulations regarding controlled substances management and dispensing protocols.
- Collaborated with interdisciplinary teams to coordinate care plans that were both comprehensive in scope yet tailored to individual patient needs.
- Streamlined pharmacy operations for increased efficiency by managing and organizing medication inventory.
- Strengthened pharmacy''s reputation within the community through exceptional service delivery, attention to detail, and genuine concern for patient wellbeing.
- Built strong relationships with healthcare providers to facilitate better understanding of patients'' needs and optimize treatment plans accordingly.
- Improved patient outcomes by accurately processing prior authorization requests and collaborating with healthcare providers.
- Participated in continuing education opportunities to remain current on industry standards, best practices, and emerging trends in the field of pharmacy.
- Alleviated staff workload pressures by proactively taking on additional responsibilities as needed within the pharmacy environment.
- Enhanced customer satisfaction with timely resolution of insurance issues, addressing concerns, and providing accurate information.
- Ensured consistent quality control measures by performing thorough audits of pharmacy documentation, procedures, and storage practices.
- Demonstrated adaptability by effectively transitioning between different roles within the pharmacy setting as needed while maintaining a high level of professionalism and competence.
- Provided valuable feedback to management for process improvements and changes that led to increased patient satisfaction levels and decreased wait times.
- Contributed to a positive work environment through effective communication, collaboration, and problem-solving efforts.
- Supported team members during peak periods to ensure seamless service delivery and optimal patient care.
- Expedited prescription fulfillment processes by efficiently entering data into computer systems, verifying dosages, and labeling medications accurately.
- Maintained regulatory compliance by staying up-to-date on industry changes and implementing appropriate adjustments to workflow procedures.
- Reduced errors in the prior authorization process by diligently reviewing patient records, insurance details, and medication interactions.
- Assisted pharmacists with medication therapy management services for improved patient adherence and overall health outcomes.
- Increased pharmacy productivity by training new technicians on best practices, company policies, and relevant software systems.
- Answered incoming phone calls and addressed questions from customers and healthcare providers.
- Stocked, labeled, and inventoried medication to keep accurate records.
- Calculated dosage, filled prescriptions, and prepared prescription labels with absolute accuracy.
- Performed wide range of pharmacy operations with strong commitment to accuracy, efficiency and service quality.
- Solved customer problems in-person or over telephone by providing assistance with placing orders, navigating systems, and locating items.
- Performed various pharmacy operational activities with strong commitment to accuracy, efficiency, and service quality.
Prior Authorization Pharmacy Technician
California Specialty Pharmacy
06.2017 - 04.2018
- Promoted a safe environment for patients through strict adherence to state regulations regarding controlled substances management and dispensing protocols.
- Collaborated with interdisciplinary teams to coordinate care plans that were both comprehensive in scope yet tailored to individual patient needs.
- Streamlined pharmacy operations for increased efficiency by managing and organizing medication inventory.
- Strengthened pharmacy''s reputation within the community through exceptional service delivery, attention to detail, and genuine concern for patient wellbeing.
- Built strong relationships with healthcare providers to facilitate better understanding of patients'' needs and optimize treatment plans accordingly.
- Improved patient outcomes by accurately processing prior authorization requests and collaborating with healthcare providers.
- Participated in continuing education opportunities to remain current on industry standards, best practices, and emerging trends in the field of pharmacy.
- Alleviated staff workload pressures by proactively taking on additional responsibilities as needed within the pharmacy environment.
- Enhanced customer satisfaction with timely resolution of insurance issues, addressing concerns, and providing accurate information.
- Ensured consistent quality control measures by performing thorough audits of pharmacy documentation, procedures, and storage practices.
- Demonstrated adaptability by effectively transitioning between different roles within the pharmacy setting as needed while maintaining a high level of professionalism and competence.
- Provided valuable feedback to management for process improvements and changes that led to increased patient satisfaction levels and decreased wait times.
- Contributed to a positive work environment through effective communication, collaboration, and problem-solving efforts.
- Supported team members during peak periods to ensure seamless service delivery and optimal patient care.
- Expedited prescription fulfillment processes by efficiently entering data into computer systems, verifying dosages, and labeling medications accurately.
- Maintained regulatory compliance by staying up-to-date on industry changes and implementing appropriate adjustments to workflow procedures.
- Reduced errors in the prior authorization process by diligently reviewing patient records, insurance details, and medication interactions.
- Assisted pharmacists with medication therapy management services for improved patient adherence and overall health outcomes.
- Increased pharmacy productivity by training new technicians on best practices, company policies, and relevant software systems.
- Answered incoming phone calls and addressed questions from customers and healthcare providers.
- Stocked, labeled, and inventoried medication to keep accurate records.
- Calculated dosage, filled prescriptions, and prepared prescription labels with absolute accuracy.
- Performed wide range of pharmacy operations with strong commitment to accuracy, efficiency and service quality.
Prior Authorization Pharmacy Technician
Briova Specialty Pharmacy
10.2014 - 04.2018
- Promoted a safe environment for patients through strict adherence to state regulations regarding controlled substances management and dispensing protocols.
- Collaborated with interdisciplinary teams to coordinate care plans that were both comprehensive in scope yet tailored to individual patient needs.
- Streamlined pharmacy operations for increased efficiency by managing and organizing medication inventory.
- Strengthened pharmacy''s reputation within the community through exceptional service delivery, attention to detail, and genuine concern for patient wellbeing.
- Built strong relationships with healthcare providers to facilitate better understanding of patients'' needs and optimize treatment plans accordingly.
- Improved patient outcomes by accurately processing prior authorization requests and collaborating with healthcare providers.
- Participated in continuing education opportunities to remain current on industry standards, best practices, and emerging trends in the field of pharmacy.
- Alleviated staff workload pressures by proactively taking on additional responsibilities as needed within the pharmacy environment.
- Enhanced customer satisfaction with timely resolution of insurance issues, addressing concerns, and providing accurate information.
- Ensured consistent quality control measures by performing thorough audits of pharmacy documentation, procedures, and storage practices.
- Demonstrated adaptability by effectively transitioning between different roles within the pharmacy setting as needed while maintaining a high level of professionalism and competence.
- Provided valuable feedback to management for process improvements and changes that led to increased patient satisfaction levels and decreased wait times.
- Contributed to a positive work environment through effective communication, collaboration, and problem-solving efforts.
- Supported team members during peak periods to ensure seamless service delivery and optimal patient care.
- Expedited prescription fulfillment processes by efficiently entering data into computer systems, verifying dosages, and labeling medications accurately.
- Maintained regulatory compliance by staying up-to-date on industry changes and implementing appropriate adjustments to workflow procedures.
- Reduced errors in the prior authorization process by diligently reviewing patient records, insurance details, and medication interactions.
- Assisted pharmacists with medication therapy management services for improved patient adherence and overall health outcomes.
- Increased pharmacy productivity by training new technicians on best practices, company policies, and relevant software systems.
- Answered incoming phone calls and addressed questions from customers and healthcare providers.
- Stocked, labeled, and inventoried medication to keep accurate records.
- Calculated dosage, filled prescriptions, and prepared prescription labels with absolute accuracy.
- Performed wide range of pharmacy operations with strong commitment to accuracy, efficiency and service quality.
- Solved customer problems in-person or over telephone by providing assistance with placing orders, navigating systems, and locating items.
- Performed various pharmacy operational activities with strong commitment to accuracy, efficiency, and service quality.
- Consulted with insurance company representatives to complete claims processing, resolve concerns, and reconcile payments.
- Counted and labeled prescriptions with correct item and quantity.
- Entered and processed patients' prescriptions into internal system.
- Counted, measured and compounded medications following standard procedures.
- Collected co-payments or full payments from customers.
- Maintained proper drug storage procedures, registries, and records for controlled drugs.
- Communicated with patients to collect information about prescriptions and medical conditions or arrange consultations with pharmacists.
- Ordered medicines daily to replenish stock and increase inventory in anticipation of need.
- Restocked pharmacy shelves with current merchandise to drive consistent peripheral sales.
- Resolved third-party billing, computer system and customer service issues.
- Managed opening and closing duties for pharmacy.
- Collaborated with physicians to obtain necessary clinical information for prior authorization submissions.
- 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.
- Verified eligibility and compliance with authorization requirements for service providers.
- Reached out to insurance carriers to obtain prior authorization for testing and procedures.
- Responded to inquiries from healthcare providers regarding prior authorization requests.
- Evaluated clinical criteria for approval or denial of services requiring pre-authorization.
- Reduced turnaround time for prior authorization requests by utilizing electronic submission methods.
- 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.
- Provided training to new staff members on the intricacies of various insurance plans and their specific prior authorization requirements.
- Input all patient data regarding claims and prior authorizations into system accurately.
- Obtained and logged accurate patient insurance and demographic information for use by insurance providers and medical personnel.
- Tracked referral submission during facilitation of prior authorization issuance.
- Reviewed appeals for prior authorization requests and communicated with payers to resolve issues.
- Researched denied claims and contacted insurance companies to resolve these issues.
Prior Authorization/Appeals and Grievances Coordinator
Optum
11.2012 - 10.2014
- Reviewed Prior Authorization submissions for meeting pa criteria and either approved or pended case to pharmacist for additional review
- Tracked referral submission during facilitation of prior authorization issuance.
- Triaged unscheduled and emergency authorizations, directing submissions to appropriate personnel for rapid response.
- Collected and processed patient liability statements prior to service.
- Fielded telephone inquiries on authorization details from plan members and medical staff.
- Submitted verbal and written notification to members and providers.
- Maintained patient confidentiality and safeguarded medical records to avoid information breaches.
- Entered appeal requests in appeals module.
- Provided outreach for additional information for appeals and grievances.
- Processed and finalized appeals and grievances within agreed-upon turnaround time.
Education
High School Diploma -
Alhambra High School
Alhambra, CA06-1992
Skills
- Performance management
- Key performance indicators
- Customer relationship management (CRM)
- Regulatory compliance
- Complex Problem-solving
- Clear communication
Certification
- Certified Pharmacy Technician (CPhT) - Pharmacy Technician Certification Board (PTCB).
Timeline
Prior Authorization Manager/Appeals Specialist
Sorrento Specialty Pharmacy
01.2024 - Current
Prior Authorization/Prior Authorization Specialist/Appeals Specialist
Whole Health Pharmacy
08.2019 - 01.2024
Prior Authorization Pharmacy Technician
Quality Home Infusions
04.2018 - 08.2019
Prior Authorization Pharmacy Technician
California Specialty Pharmacy
06.2017 - 04.2018
Prior Authorization Pharmacy Technician
Briova Specialty Pharmacy
10.2014 - 04.2018
Prior Authorization/Appeals and Grievances Coordinator
Optum
11.2012 - 10.2014
High School Diploma -
Alhambra High School
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