Raman Baghel

My role as a clinical pharmacy reviewer in the Prior Authorization Department. As a pharmacist, provide a formulary alternative drug (Insurance covered medication) on behalf of a non-formulary drug (Not included in insurance). Using SAP for payment reimbursement. Already provided Disease name or ICD10 codes include drug name. We need to check patient history, drug and drug interaction, side effects, not effective for a patient, and then we have to approve if it is on the list of preferred drugs.

Claims Assessor. Direct Handling Prescriptions from different countries need to be assessed by adding numerous data in the software like Diagnosis code (ICD9), Medical Benefits, Pre-authorization, Patient history, Patient information, Evaluate claim risk, explanation of benefits (EOB) is sent out to the member.

Refinement and redaction (Blackout) of the clinical data after reading the periodic safety update report (PSUR, PBRER) and Clinical ADR report