1. ALEXANDER KNIGHTON
1141 Camellia Court | San Leandro, CA 94577 | 510-648-6379 | alexander_knighton@my.hnu.edu
PROFESSIONAL SUMMARY
Case manager witha diverse background, including 7 years ofexperience incustomer andprovider focused support services,
reimbursement andhealthcare relatedresearch/expertise, database management, pharmacy/drug services and aneducationin
the Biological sciences. Currentlyseeking a long term customer/provider/technical focusedsupport role in a professional pharma
related setting.
EDUCATION
Bachelor of Science, Major:Biology, Minor:English, Magna cum laude
Holy Names University, Oakland
SKILLS
 Workingknowledge of pharmacyterminology, sig codes, ICD 10 knowledge, TARS, PA’s, government payer procedures,
generic medication names, expedient data entryskills, email, voicemail communications;database management
 capacityto work independentlywithminimalsupervision,
 Strong customer service skills;experience with patient, provider and pharmacyservices ina corporate and managed care
setting.
 Microsoft Office; Word, Powerpoint, Excel, Access (all versions);Mac’s;internet researchresources; call center technology;
Medimpact PBMsoftware, Salesforce (SFDC) software
 Typing speedof 68 WPM
WORK
Esbriet Access Solutions Case Manager (Contract Position)
Genentech
Sep.2015 to
Jan.2016
 Represent the drug manufacturer’s patient and MD support program. Acts as a liaisonbetweenpatients, providers,
pharmacies, MD’s, and insurance carriers within a high volume call center environment to ensure services are provided in
the least restrictive andcostlymanner.
 Educates, informs andguides patient throughthe reimbursement process for Esbriet byidentifyingfinancialbarriers and
facilitatingreferralsto alternative financial options (GenentechAccessto Care Foundation, nonprofit organizations, brand
name copaycards, etc.)for patients who cannot afford the required copayments or are underinsuredor uninsured
 Facilitates internal investigations intocoverage, benefits, payer policies;conveys those results to the appropriate parties
and followup regularlyto ensure compliance with payer requirements, practices, timelines(ala appeals for deniedPA’s)
 Act as a professional subject matter resource onprivate andgovernment payer requirements;reimbursement funding
resources; specialtypharmacies;Genentech internalresources (medcom, tech support, drug safety, etc.)
Licensed PharmacyCoordinator (Contract Position)
Santa Clara FamilyHealth Plan
Dec.2014 to
Sep.2015
 In compliance withstate and federal regulations, work semi-independentlyto reviewprior authorizationfaxes, perform
data entryinto MedResponse system software
 Reviewandapprove authorization requests inaccordance withapprovedPharmacyClinical guidelines, escalate reviews as
needed
 Researchnecessaryinformationto resolve case bycase dilemmas using available resources;contact providers to obtain
necessarymedical info;maintainaccurate andauditable documentationof case review;ensure regulatorycompliance with
PA turnaroundtimes and deliver appropriate notificationto members andproviders
 Manage the pharmacyphone queue during business hours, resolvingissueswith pharmacies, PBM’s, andproviders
 Act as a professional subject matter expert for SCFHPmember benefits, review standards, guidelines, authorizations or
benefit limitations
LicensedPharmacyTechnician
CVS Pharmacy
April 2013 to
Dec.2015
 In compliance withstate and federal regulations includingHIPAA, work alongside a team oflicensedtechnicians and a
registered pharmacist to create and maintain patient records, transcribe electronic andwritten prescriptions, mediate
betweeninsurance companies and clients, complete TAR request forms, create andfollowupwithPA requests, follow up
TAR case status onMediCal/Medicare websites, collect necessarydocumentationfrommedicalproviders, communicate
with PBM’s to determine what steps are requiredfor PA’s, communicate to members whenPA has been approved,
document historyof insurance claims inpatient profiles, escalate issues as necessary