Grabiel Perez
Isabela
Summary
Results-driven pharmacy operations professional with a strong background at Optum, recognized for enhancing workflow efficiency and resolving customer issues effectively. As an Internal Auditor, demonstrated expertise in control process validation and a commitment to delivering high-quality auditing results. Equipped with extensive experience in customer service call center operations, consistently ensuring client satisfaction and operational excellence.
Overview
24
24
years of professional experience
Work History
Customer Service Auditor
Optum
San Juan
04.2022 - Current
- Detected department-level problems by monitoring activities and reporting on findings.
- Used consistent and fair assessment procedures to achieve optimal audit results.
- Highlighted compliance issues for management team.
- Completed reports using Qfinity software for reporting agent evaluations.
- Performed daily audits of call center service calls.
- Established continuous evaluation system to stay current on Arkansas Medicaid Independent Assessment Call Center performance.
- Provided feedback for customer service agents and issue resolution to increase QA satisfaction levels.
- Audited customer account information to identify issues and develop solutions.
Prior Authorization- Appeals Pharmacy Technician
OptumRx
San Juan
09.2021 - 02.2022
- Maintained high level of professionalism when speaking to doctors and insurance companies.
- Followed all Medicare, Medicaid, HIPAA, and private insurance regulations and requirements.
- Notified ordering providers of denied authorizations.
- Coordinated resolutions for issues and appealed denied authorizations.
- Applied knowledge of Medicare, Medicaid and third-party payer requirements utilizing on-line eligibility systems to verify patient coverage and policy limitations.
- Performed detailed medical reviews of prior authorization request, following established criteria and protocols.
- Scheduled peer to peer reviews for physicians to discuss medical necessity with insurance providers.
- Clarified patient inquiries and questions to update patient account information in computer system.
- Collaborated with internal departments to provide account status updates.
- Provided accurate information to all parties, including patients, insurance providers, healthcare staff and office personnel by using effective written and verbal communication skills.
- Used PAS and Navigator Software to input prior authorization requests and other important medical data into system.
Pharmacy Technician
Walgreen's Pharmacy
Isabela
09.2020 - 11.2021
- Maintained clean and organized pharmacy shelving and work areas.
- Verified patients identities at pickup to prevent sale of wrong medications.
- Managed inventories, rotated stock, removed expired or damaged drug products and resolved discrepancies in drug counts.
- Efficiently processed cash register transactions for new and refilled prescription orders.
- Created new customer profiles and updated changes such as demographics, allergies and new medications in pharmacy computer systems.
- Assisted pharmacist with clearing high volume of prescriptions and responded to customer questions.
- Worked with insurance companies to process claims, resolve problems and obtain payments.
- Consulted with customers via telephone or in-person to assist with navigating pharmacy systems and completing requests.
PHARMACY TECHNICIAN INTERN
HOSPITAL BUEN SAMARITANO
Aguadilla
12.2018 - 11.2019
- Received and verified daily incoming drug inventories, reported discrepancies and logged items into inventory system.
- Managed inventories, rotated stock, removed expired or damaged drug products and resolved discrepancies in drug counts.
- Received, reviewed, dispensed and labeled prescriptions daily with expert accuracy.
- Maintained clean and organized pharmacy shelving and work areas.
- Met regulatory recordkeeping requirements by documenting pharmacy log with information on prescriptions picked up by patients.
- Assisted pharmacist in daily operations tasks and administrative tasks.
PRODUCTION OPERATOR – KIT PULLER OPERATOR
MICRON TECHNOLOGY
Aguadilla
01.2006 - 01.2018
- Control of production equipment for electronic memory modules, monitoring of production process and carrying out basic testing and quality checks.
- Pull orders of materials to be used in production operations, transport pulled items from the storage area to the production area and inspect items for quality and quantity, verifying lot and item numbers and process that data into production software.
QUALITY INSPECTOR – PROCESS CONTROL OPERATOR
SOLECTRON
Aguadilla
01.2004 - 01.2006
- Inspection of incoming materials by confirming specifications; conducting visual and measurement tests; rejecting and returning unacceptable materials.
- Approves in-process production by quality specifications communicating required adjustments to production supervisor.
- Verifying finished products and returning products for re-work.
- Compiles data of measurements taken of machine operations and compares actual measurement with measurements from specifications book.
LEAD OXIDE PRODUCTION OPERATOR – WASTE TREATMENT OPERATOR
COMMONWEALTH BATTERIES INC
Isabela
01.2003 - 01.2004
- Established operational parameters for consistent production of “leady Oxide”.
- Established proper water treatment procedures for used water in order for it to be recycled into operations.
Education
Associate of Applied Science - Pharmacy Technician
National University College - Arecibo
10 2019
Some College (No Degree) - Computer Science And Programming.
Universidad Interamericana Aguadilla
High School Diploma -
Francisco Mendoza High School
Isabela1994
Skills
- Pharmacy operations
- Ordering and stocking medications
- Verifying orders
- Drug inventory control
- Problem-solving skills
- Quality assurance and control
- Supporting pharmacy operations
- Labeling prescriptions
- Documentation ability
- Quality inspections
- Knowledgeable in PAS and Navigator software
- Insurance information oversight
- Conflict resolution
- Recordkeeping and data entry
- Insurance Verification
- FDA compliance
- Patient insurance authorizations
- Account management
- Call center operations
- Account updating
- Data gathering
- Resolving customer issues
- Workflow Optimization
- System documentation
- Service call expertise
- Customer communications
- Data entry
- Quality control
Languages
Excellent verbal and written communications skills, fully bilingual in Spanish and English
References
References
Available upon request.
Timeline
Customer Service Auditor
Optum
04.2022 - Current
Prior Authorization- Appeals Pharmacy Technician
OptumRx
09.2021 - 02.2022
Pharmacy Technician
Walgreen's Pharmacy
09.2020 - 11.2021
PHARMACY TECHNICIAN INTERN
HOSPITAL BUEN SAMARITANO
12.2018 - 11.2019
PRODUCTION OPERATOR – KIT PULLER OPERATOR
MICRON TECHNOLOGY
01.2006 - 01.2018
QUALITY INSPECTOR – PROCESS CONTROL OPERATOR
SOLECTRON
01.2004 - 01.2006
LEAD OXIDE PRODUCTION OPERATOR – WASTE TREATMENT OPERATOR
COMMONWEALTH BATTERIES INC
01.2003 - 01.2004
High School Diploma -
Francisco Mendoza High School
Some College (No Degree) - Computer Science And Programming.
Universidad Interamericana Aguadilla
Associate of Applied Science - Pharmacy Technician
National University College - Arecibo