Hemangi Shah
Charlotte
Summary
4+ years of experience in Pharmacy Environment ;2+ years of Pharmacy Technician in Trainee; 2+ years of clinical Review Technician 1+ years of experience in customer service and retail environment Dedicated, flexible and hardworking professional Excellent verbal and written communication skills Capability of multitasking Ability to learn quickly and work independently as well as in fast paced team environment
Overview
4
4
years of professional experience
1
1
Certification
Work History
Prior Authorization Representative
Orsini Specialty Pharmacy
06.2023 - Current
- Streamlined workflow by initiating requests and faster approval turnaround times, handling high volume of insurance verification tasks.
- Processed new medication and refill requests for authorization.
- Verified eligibility and compliance with authorization requirements for service providers.
- Fielded telephone inquiries on authorization details from plan members and medical staff.
- Provided exceptional customer service, addressing inquiries from both patients and healthcare providers promptly and professionally.
- Ensured compliance with HIPAA regulations by maintaining strict confidentiality in handling sensitive patient information.
Clinical Review Technician
Prime therapeutics
02.2021 - 03.2023
- Processing request of Prior Authorization, Coverage Exceptions, Formulary Exceptions, Quantity Exceptions, Tier exception, Step therapy for delegated Utilization Management (UM)
- Entering PA for accurate quantity and exact duration approved by pharmacist with error-free detailing (Specifically for specialty medications)
- Successfully tracking and following the different processes of different clients for Example Horizon NJ, Florida Blue , HCSC
- Providing proper and necessary information to members, prescribers, and clients by creating relevant letters and by sending them Via Fax and mail
- Cleared all CIC's which was mandatory for training by 80% or above.
Pharmacy Technician Trainee
A2Z Healthmart Pharmacy
01.2021 - 02.2021
- Worked as pharmacy technician under pharmacist as per experience
- Maintained record for rental surgical supplies like wheelchairs, walking crutches etc
- Processed Medicare prescriptions for surgical equipment
- Made a file of paperwork for medicare processes by collecting information
- Managed to prepare orders of nutrition drinks for delivery.
Pharmacy Technician Trainee
Wackerly Pharmacy
03.2020 - 11.2020
- Assisted pharmacist and fellow pharmacy technicians with daily duties as assigned
- Efficiently calculated dosages, prepared prescription labels, dispensed medication and prepared prescriptions by counting, weighing, pouring and packing for approval by pharmacist
- Delivered prescriptions to customers at their residence
- Observed inventory levels and placed orders as needed (Inventory Management)
- Experienced in taking prescriptions over fax, written and e-prescriptions
- Experienced in handling hazardous and controlled drugs
- Managed weighing, measuring and generated labels for UPS.
Education
Bachelor of Science in Chemistry -
Maharaja Sayajirao University of Baroda
05.2017
Bachelor of Science in Mathematics -
Maharaja Sayajirao University of Baroda
05.2016
Skills
- Microsoft excel, power point and word
- Prescription processing
- Insurance authorization
- Insurance claim processing
- Covermymeds, RX30
- Insurance Verification
- Prescription Coordination
- Communication fluency
- Medical and pharmaceutical terminology
- Medication inventory management
- Computer proficiency
- Benefit Coverage
- HIPAA Compliance
Work Authorization
US Citizen
Certification
Certified Pharmacy Technician
Timeline
Prior Authorization Representative
Orsini Specialty Pharmacy
06.2023 - Current
Clinical Review Technician
Prime therapeutics
02.2021 - 03.2023
Pharmacy Technician Trainee
A2Z Healthmart Pharmacy
01.2021 - 02.2021
Pharmacy Technician Trainee
Wackerly Pharmacy
03.2020 - 11.2020
Bachelor of Science in Chemistry -
Maharaja Sayajirao University of Baroda
Bachelor of Science in Mathematics -
Maharaja Sayajirao University of Baroda
Certified Pharmacy Technician
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