Lyndsey C. Nichols

1331 E. 4170 S.
Salt Lake City, UT 84124

(801)755-5504

Lyndsey.C.Nichols@gmail.com

 

 

Medical Review Institute of America (MRIoA)

March 13, 2014 – Present

Pharmacy Analyst

·  Provide support and assistance to in house physicians and pharmacists

·  Enter and screen pharmacy prior authorizations and appeals

·  Contact external physician reviewers for case assignment, to obtain status, and answer questions regarding the review

·  Complete and review final appeal reports for consistency, grammar, formatting, quality, and relativity

·  Process prior authorization requests for various clients via various client specific systems

·  Acknowledge and respond to all client and reviewer communications in a timely manner

·  Screen all prior authorizations and appeals for possible discrepancies and report them to the internal physician reviewers

·  Log client due times and ensure that all cases are returned before the requested due time and all reports are reviewed for quality and accuracy

·  Analyze all information submitted by clients and external physician reviewers, including medication names, diagnoses, medical procedures, medical records, denial/approval rationale, and case notes

·  Send clarifications to external reviewers when necessary

·  Follow strict HIPAA and URAQ policies and procedures at all times

·  Document all internal and external correspondence accurately and within the appropriate time frame

·  Provide feedback and answer questions for both internal and external physician reviewers

·  Contact clients to obtain additional information or records when necessary

 

Metasource, LLC

July 20, 2013 – March 10, 2014

Synapse Customer Service

·  Third party magazine customer service for Time Warner, Inc.

·  Respond to customer inquiries via email, phone and postal mail

·  Process all inquiries in an efficient and timely manner

·  Maintain excellent spoken and grammatical accuracy

·  Process all work quickly and efficiently

·  Contact magazine fulfillment houses to solve customers’ delivery issues

·  Consistent top performer in both speed and accuracy

·  Demonstrated willingness and ability to take on additional assignments whenever necessary

 

Verisys Corporation

October 17, 2011 – July 16, 2013

Licensing Coordinator

·  Consistent top performer in speed and quality for each department and queue assigned

·  Excellent speed and accuracy

·  Experience and knowledge in many departments and processes within the company. (Licensing, Sanctions, Data Entry, Data Entry QA, Abuse, Offender, and Content)

·  Demonstrated willingness and ability to switch from various tasks and responsibilities while continuing to maintain both speed and accuracy

·  Demonstrated ability to learn and adapt to new processes quickly and efficiently

·  Knowledge of various QA processes, particularly in data entry, as well as sanctions

·  Locate and verify healthcare provider licenses and credentials and determine whether any sanctions or discipline exist

·  Contact state healthcare boards to verify provider licenses and board licensing processes

·  Compare candidates for hire to national and nurse aide abuse and offender databases to verify eligibility for employment

·  Assist Verisys new hires in understanding the processes and duties associated with their position, answer questions, and provide guidance wherever necessary

 

Altius Health Plans

July 7, 2010 – October 17, 2011

Customer Service Operations

·              Customer service in a call center environment

·              Review member’s insurance claims and health benefits

·              Assist customers and providers in understanding and processing claims and benefits

·              Resolve escalated issues in an efficient and timely manner

·              Adhere to strict attendance and customer service policies

·              Direct contact for members, billing offices, and all health care providers

·              Work directly with team members to solve issues and reach company goals

·              Solve complicated pharmacy and authorizations issues

·              Document and administer scanned written correspondence to various departments throughout the company

·              Maintain a positive image and experience for all customers

·               Work directly with other departments both inside and outside the company

·              General office, such as fax, mail, scan, print and copy documents

·               Operate multi-line telephone

·               Use of Microsoft Outlook, as well as medical IDX system

·               Input CPT and diagnosis codes into company system

 

Loose in the Lab

December 2009 – June 2010

Workshop/Meeting Director & Office Admin.

·              Plan and schedule company meetings throughout the country

·              Book travel and hotel accommodations for company employees and self

·              Work directly with hotel catering/sales managers to ensure company and customer satisfaction

·              Receive and process all workshop registrations

·              Receive and process company orders via QuickBooks

·              Answer all incoming calls and manage company e-mail

·              Address all customer questions and concerns

·              Oversee company speakers and attend to their wants and needs

·              General office and data collections

·              Occasional marketing, web design, and editing of company documents

·              Use of all Microsoft Office documents as well as QuickBooks, Bridge, InDesign, and Outlook

 

 

 

 

 

Skills/Attributes

·              Ample experience in the healthcare field as well as production and office management

·              Excellent computer and office skills

·              Type 90 wpm with excellent accuracy

·              Type fast and accurate in 10-key

·              Efficient with all Microsoft Office documents, QuickBooks, IDX and Adobe Photoshop

·              Ample experience in travel coordination and meeting planning

·              Excellent interpersonal and customer service skills

·              Excellent grammar and vocabulary skills

·              Detail oriented, strong ability to multi-task and meet strict deadlines

·              Ability to work independently and in a team environment

·              Eager and able to learn new systems and processes quickly and efficiently

·              Friendly and outgoing personality

 

Education

·              Eagle Gate College, Diploma in Pharmacy Technician Studies, Graduated October 2013

·              Murray High School, High School Diploma, Graduated May 2008

·              Received honors in Arts and Recreation, Murray High School

·              Debate Team and Literary Magazine Staff (Pros Editor), Murray High School

 

Licenses

·              National Pharmacy Technician Certification Board, Effective Date: November 25, 2013

·              Utah Pharmacy Technician License, License# 8569771-1717, Effective Date: March 4, 2014, Status: Active and in good standing