Nash Fenteng

Hardworking and enthusiastic Certified Pharmacy Technician with over 10 years of experience in fast-paced healthcare and pharmacy benefit management environments. Skilled at collaborating with cross-functional teams to ensure regulatory compliance, mitigate risks, and enhance operational efficiency. Possesses strong knowledge of HIPAA, HITECH, HITRUST, NIST standards, and RMF frameworks, with hands-on experience in compliance audits, claims adjudication, and process optimization.

Proven ability to problem-solve, adapt, and deliver measurable improvements in pharmacy operations.

Pharmacy Operations Rep - HCSC

(2024-08)

• Resolved complex pharmacy claims, pricing discrepancies, and coding issues for customer service teams, pharmacy coordinators, pharmacists, and members.
• Collaborated with internal departments and external vendors to investigate and resolve pharmacy-related concerns, ensuring timely and accurate outcomes.
• Assisted in evaluating claim processing workflows to identify inefficiencies and recommend improvements for operational effectiveness.
• Maintained compliance with regulatory standards by documenting resolutions and ensuring adherence to pharmacy policies and procedures.
• Delivered clear communication and guidance to stakeholders, enhancing customer satisfaction and strengthening cross-functional relationships.
• Facilitated Medication Therapy Management (MTM) by coordinating with pharmacists to review patient medication regimens, identify therapy gaps, and support interventions that improve adherence and clinical outcomes.

Pharmacy Operations Specialist - Wellsense Health Plan - Boston, MA

(2024-01 - 2024-07)

• Processed and reviewed prior authorization requests via fax, phone, and electronic systems in compliance with regulatory and accreditation standards.
• Applied clinical policy criteria to authorization reviews and interpreted member eligibility, claim history, and pharmacy program data.
• Communicated determinations to members and providers through calls, faxes, and letters.
• Entered and validated medical and pharmacy data in accordance with NCQA accreditation requirements.
• Provided pharmacy-related customer service to internal and external stakeholders.

Pharmacy Benefits Coordinator - Paydhealth - Dallas, TX

(2020-07 - 2024-01)

• Adjudicated pharmacy claims, resolved processing issues, and ensured accuracy of quantity and day supply.
• Reviewed prior authorization cases for completeness and compliance with PBM formulary criteria.
• Served as primary contact for enrollment tasks and inquiries, ensuring timely resolution.
• Conducted benefits investigations and identified patient assistance opportunities to reduce out-of-pocket costs.
• Built strong relationships with pharmacies and providers to streamline claims processing.
• Analyzed claim data to identify trends, recommend cost-saving measures, and improve program efficiency.

Sr. Coordinator – Individualized Care - Cardinal Health - Lewisville, TX

(2019-01 - 2020-07)

• Managed inbound/outbound calls with patients, providers, and payers to resolve inquiries.
• Reviewed patient assistance applications and coordinated access to therapy.
• Investigated claim issues and conducted benefits investigations with payers.
• Assisted patients with foundation programs and coordinated pharmacy care for positive drug therapy outcomes.

CPHT III PBM Operations Specialist - DaVitaRx - Coppell, TX

(2015-07 - 2018-12)

• Reviewed non-formulary and prior authorization requests against plan criteria.
• Escalated formulary exceptions to pharmacists and documented findings for clinical teams.
• Conducted audits to identify fraudulent activities and recommended preventive measures.
• Developed SOPs to improve operational efficiency and staff performance.
• Triaged patient calls for pharmacist-led medication reviews.

Configuration Analyst (CPHT Rep III) - CVS Health - Richardson, TX

(2010-03 - 2015-07)

• Managed plan benefits GPI coding, configuration changes, and testing.
• Conducted user acceptance testing for new configuration logic.
• Reviewed formulary data files and maintained client documentation.
• Collaborated with cross-functional teams to ensure accurate benefit design implementation.

Certified Pharmacy Technician - Walgreens - Murphy, TX

(2010-02 - 2012-01)

• Processed prescriptions, performed data entry, and managed inventory.
• Assisted patients with prescription issues and prior authorization requests.
• Adjudicated third-party claim rejections and explained benefits to patients.

Bachelor of Science - Healthcare Administration (Information Systems) - University of Phoenix (2018-02)