Moira Nix
Loranger
Summary
Dynamic professional with over 6 years of experience enhancing customer interactions and delivering innovative service solutions. Expertise in conflict resolution, communication, and problem-solving drives exceptional customer satisfaction and loyalty. Proven team collaborator who adapts seamlessly to evolving needs while maintaining a steadfast focus on achieving results through efficient and empathetic service. Recognized for reliability and a proactive approach to fulfilling customer and organizational objectives.
Overview
6
6
years of professional experience
Work History
PBM Customer Service Representative
Rightway Healthcare
Remote
11.2023 - Current
- Provide support to pharmacies, providers, and members regarding pharmacy benefits and claims processing.
- Executed initiation and management of prior authorizations for members and providers.
- Facilitated communication of prior authorization status updates to members.
- Facilitated resolution of claim processing issues for pharmacies to ensure accurate reimbursement.
- Clarified benefit structures and copay responsibilities to members, ensuring comprehensive understanding.
- Coordinated discussions with pharmacists to identify suitable medication alternatives and support member needs.
- Created and processed overrides as needed.
- Executed efficient utilization of Tredium MHK and Advocate systems to streamline task management.
- Designed and delivered training programs to enhance employee performance and engagement.
- Collaborated with management to identify skill gaps and create targeted training solutions.
- Supported representatives in navigating difficult interactions with customers, offering guidance on appropriate de-escalation techniques when needed.
Customer Service Representative
NTT DATA Services
Remote
06.2023 - 10.2023
- Delivered high-quality customer service in a fast-paced call center environment.
- Resolved complex customer issues while maintaining professionalism under pressure.
- Processed claims for medical offices, pharmacies, and hospitals.
- Managed and processed prior authorization requests.
- Resolved customer inquiries efficiently using CRM software to enhance satisfaction and retention.
- Responded to customer requests for products, services, and company information.
Certified Pharmacy Technician
Floyd's Family Pharmacy #1
Ponchatoula, LA
01.2023 - 05.2023
- Executed inventory control measures by receiving and verifying drug shipments for compliance and accuracy.
- Performed precise medication retrieval, counting, measuring, and compounding to ensure patient safety.
- Facilitated accurate processing of insurance claims to ensure timely resolution of billing discrepancies.
- Supported pharmacists in clarifying prescriptions and enhancing operational efficiency.
- Ensured adherence to pharmacy safety and regulatory standards.
- Executed processing of prior authorizations for compounded and non-compounded prescriptions.
Certified Pharmacy Technician
Family Health Centers LLC
Albany, LA
12.2019 - 12.2022
- Oversaw the workflow of written, oral, and electronic prescriptions, maintaining high standards of accuracy and efficiency.
- Monitored inventory processes and enforced compliance with state and federal regulatory standards.
- Facilitated direct communication with provider offices to clarify prescription details.
- Facilitated prior authorizations and managed insurance billing to ensure compliance and efficiency.
- Executed administration of immunizations, including COVID-19, influenza, pneumonia, and Zostavax.
- Executed processing of up to 600 prescriptions daily, ensuring 100% accuracy in high-volume environments.
Education
Nationally Certified Pharmacy Technician - Pharmacy Technician
Northshore Technical Community College
Hammond, LA01-2020
Skills
- Prescription Processing & Fulfillment
- Insurance Billing & Reconciliation
- Prior Authorizations
- PBM Operations
- Data Entry & Order Entry
- PioneerRX Proficiency
- Tredium, MHK & Advocate Systems
- Sterile Compounding Knowledge
Timeline
PBM Customer Service Representative
Rightway Healthcare
11.2023 - Current
Customer Service Representative
NTT DATA Services
06.2023 - 10.2023
Certified Pharmacy Technician
Floyd's Family Pharmacy #1
01.2023 - 05.2023
Certified Pharmacy Technician
Family Health Centers LLC
12.2019 - 12.2022
Nationally Certified Pharmacy Technician - Pharmacy Technician
Northshore Technical Community College