Managing Prior Authorizations for Medications for a Primary Care Practice in New York by working diligently with Providers, Nurses, Practise Managers, Patients and their Insurances plans.

My Job Responsibilities here included the following.

Interact with Physicians/Doctors, Health information services (HIS) coding staff and other members of the healthcare team to ensure the accuracy and completeness of clinical documentation, support resource utilization, length of stay and patient outcomes.
Educate all members of the patient care team and participate in the development of educational tools and programs for the healthcare team.
Collect and analyze data to determine the effectiveness and efficiency of clinical documentation processes and physician participation.
Work on HEDIS to measure the quality of Health Plans using eClinicalWorks (eCW) and patient\'s Electronic Health Record (EHR).
Analyze and Recommend Medical Diagnostic Tests to Physicians such as Colonoscopy, Mammography, CT scans, X-rays, Diabetes, Tobacco & Depression Screening etc. 
Make Efficiency Reports of Providers on monthly and weekly basis to be sent to NCQA ( National Committee of Quality Assurance).
Compile Data using Excel Sheets.
Work on several Insurances such as Healthfirst, Wellcare, Elderplan, Medicare, Medicaid, Blue Cross Blue Shield etc.
Work with Physicians on patient\'s medical records to compare health plan performance.
Update patient\'s ICD-9 codes to ICD-10.
Coordinate with Physicians by updating notes on eCW on daily basis.
Work on ICD-10 preventive and diagnostic codes according to Health Insurance Portability and Accountability Act (HIPAA).
Thorough familiarity with CPT, ICD-10, HCPCS and HIPAA Guidelines. 
Following up on Doctor\'s task assignments and Client Communication. 
Training and Performing Quality Control Checks on performance of new coders and junior staff. 
Developing and Implementation of SOPs. 
EMR/EHR Maintenance. 
Working on Microsoft Excel, Ms word, Ms PowerPoint.

Supervised Operations and Logistics of Raw Materials Store and Warehouse Inventory Control.
Dispensed Raw materials under my supervision for the production of Tablets, Capsules, Syrups, Injectables and various other Pharmaceutical drugs.
Supervised the performance of junior staff in the Raw Materials Store.
Maintained record of inflow and outflow of raw materials from the warehouse.
Gained insights into the business practices of the Pharmaceutical Industry.
Attended and practically observed Production Department.

Gained experience as a Community Pharmacist.
Performed patient counselling on rational, safe and effective use of drugs.
Handled the tasks of conducting training sessions to promotional staff of various companies in pharmacy.
Controlled and maintained record of Prescription medications and Narcotic items.
Handled short expiry stock record by communicating to different distributors.
Ensured on warranty purchase by governmental authorized distributors.
Assigned the responsibilities of evaluating employee\'s performance as well as suggested ways to increase productivity.
Supervised and monitored the pharmacy staff to ensure high quality service to the customer.

Internship in Dispensing, Aseptic, Clinical Services, Radio Pharmacy & Inventory Control.
Maximizing the clinical effect of medicines and using the most effective treatment for each type of patient.
Minimizing the risk of adverse affects, monitoring the therapy course and the patient\'s compliance with the therapy.
Checking prescriptions for errors and ensuring appropriate, safe and rational drug use for each patient.
Providing advice on the dosage and the most appropriate form of medications for example tablet, injection, ointment or inhaler.
Participating in ward rounds, noting down patient\'s drug histories and getting involved in making decisions on appropriate treatment.
Ensuring medicines are stored safely and according to storage conditions.
Supervising the work of less experienced and less qualified staff.
Answering questions about medicine to hospital staff and the general public.

Practically observed and studied operations and procedures of various departments such as Quality Control, Production, Materials Control Department, Accounts and Sales/Marketing department.