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Skills

  • Clinical Documentation Analysis
  • Pharmacy operations management
  • Risk mitigation strategies
  • Customer service, education, and counseling
  • Verifying orders
  • Medication dispensing and immunizing
  • Drug delivery mechanisms
  • Cost savings initiatives
  • Confidentiality and HIPAA
  • Drug formulary reevaluation

Work Experiences

  • Managed and mentored staff of 16 Prior Authorization Pharmacists using workflow optimization and process improvement and delivering focused metric training.
  • Championed the adoption of electronic prior authorization (ePA) technologies, cutting down manual processing time from 4 days to 12 hours.
  • Achieved $7 savings for the pharmacy department.
  • Communicated with insurance companies to resolve escalated cases, resulting in $11 savings for the pharmacy department over 2021.
  • Used careful oversight and cross-functional collaboration to supervise the dispensation of controlled substances, including category and program.
  • Addressed barriers to coverage.
  • Gave immunizations and met with patients for medication consultations, effectively raising pharmacy's health-care awareness.
  • Achieved a 19% reversal rate.
  • Hired, trained, and coached 2 Prior Authorization Pharmacists, resulting in a 13% increase in overall performance.
  • Advised physicians on formulary alternatives.

Summaries

  • Addressed approval delays.
  • Calculating doses, preparing compounds, and securing storage to protect inventories are all skills I have.
  • In a busy pharmacy environment, highly adaptable Prior Authorization Pharmacist providing medical assistance and support to patients.
  • Professional who is well-organized and respectful keeps a flexible schedule and adapts to changing business and customer needs.
  • Pharmacist with experience working in hospital, community, and clinic pharmacies.
  • Excellent communication skills, as well as a strong desire to educate patients about medication therapies.
  • Advanced communicator with staff, clients, management, and healthcare administrators at all levels.
  • Informs patients about medication side effects, contraindications, and benefits.
  • Accomplished in managing prior authorization processing, routinely achieving 61% approval rates for high-cost biologics and specialty therapies.
  • Accomplished this over three years.

Accomplishments

  • Launched an innovative cost-saving initiative that decreased specialty medication costs for low-income patients, saving over $9 annually for procedure.
  • Collaborated with 16 cross-functional teams to improve coordination during prior authorization requests, ultimately reducing turnaround times by 57%.
  • Provided advanced clinical expertise in process approval workflow, leading to a 24% increase in patient therapy adherence within 12 months.
  • Helped integrate clinical pharmacy software with payer systems, decreasing approval cycle times by 7% and reducing manual entry errors.
  • Documented and resolved framework which led to process.
  • Utilized in-depth knowledge of the health insurance industry to resolve payer issues, leading to 7 in cost savings over three years.
  • Developed tailored educational workshops for physicians, decreasing denied prior authorization requests by 47% across the healthcare group.
  • Monitored regulatory updates and payer policy changes to maintain compliance, achieving 72% fewer approval delays for high-cost medications within the past year.
  • Developed prior authorization training materials for new hires, reducing onboarding time by 4 weeks while improving accuracy in authorization submissions.
  • Used clinical documentation analysis to identify request bottlenecks, reducing turnaround time for prior authorization approvals by 12 days.

Affiliations

  • American Pharmacists Association (APhA)
  • Health IT Certification for Prior Authorization Administrators (PAA)
  • International Society for Pharmacoeconomics and Outcomes Research (ISPOR)
  • Pharmaceutical Research and Manufacturers of America (PhRMA)
  • State Pharmacy Association North Carolina
  • American Society of Safety Professionals
  • American Society of Health-System Pharmacists (ASHP)
  • International Council of Nurses
  • Pharmacy Quality Alliance (PQA)
  • Association of Clinical Research Professionals (ACRP)

Certifications

  • Certified Public Accountant
  • Healthcare Compliance Certification (CHC)
  • Microsoft Certified Systems Engineer (MCSE)
  • Certified Pharmacy Technician (CPhT)
  • Certified Prior Authorization Manager (CPAM)
  • Board Certified Infectious Diseases Pharmacist (BCIDP)
  • Certified in Health Care Compliance (CHC)
  • CompTIA Network+
  • Introduction to Prior Authorization Certification - American Pharmacists Association (APhA)
  • ServSafe

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