Nohely Ghiorzo

Assisted with case reviews in new hire training classes and reviewed health plan criteria to determine coverage for retail pharmacy authorization requests. Trained on reviewing NY medpharm and entered approvals into PBM, following guidelines for plan exclusions.

Assisted with case review in new hire training classes and reviewed health plan criteria and resources to determine coverage for retail pharmacy authorization requests. Trained on reviewing NY medpharm to provide support if needed and entered approvals into PBM.

Processed prior authorization requests for retail pharmacy and medpharm received via fax, phone, and Salesforce. Identified appeals, reconsiderations, and NCH (Evolent) cases, entering approvals into PBM and troubleshooting rejected claims.

Assisted pharmacists with scheduling and delegating pharmacy tasks, using RX Connect for entering prescription data and resolving billing issues. Managed inventory, including daily outside vendor orders, weekly warehouse orders, returns, specialty orders, and recalls.

Assisted pharmacists with scheduling and delegating pharmacy tasks, using RX Connect for entering prescription data and resolving billing issues. Managed inventory, including daily outside vendor orders, weekly warehouse orders, returns, specialty orders, and recalls.

Completed high school education, earning a diploma. Focused on general studies to prepare for future endeavors.