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Skills

  • Workflow Optimization
  • Medical necessity review
  • Patient wait time reduction strategies
  • Loss prevention controls
  • Clinical justification preparation
  • FDA Drug Safety Guidelines
  • Pharmacy operations management
  • Medicare and Medicaid process
  • Quality review processes
  • Verifying orders

Work Experiences

  • Communicated with insurance companies.
  • Informed patients about potential drug interactions, side effects, and the best ways to take their medications.
  • Collaborated with providers to streamline the prior authorization process.
  • Collaborated with payers to forecast upcoming formulary changes, allowing for better prioritization of prior authorizations, which reduced patient delays by 18 days.
  • Coordinated with multidisciplinary teams to reevaluate drug formularies, leading to increased patient adherence and improved therapeutic outcomes.
  • Advised physicians on formulary alternatives.
  • Championed the adoption of electronic prior authorization (ePA) technologies, cutting down manual processing time from 4 days to 12 hours.
  • Advised physicians on formulary alternatives, increasing on-formulary prescription fills by 37% while maintaining patient outcomes.
  • Helped patients save money on their medical bills by suggesting generic alternatives to prescription medications.
  • Coordinated with administrative personnel.

Summaries

  • Dedicated to learning, growing, and succeeding in Miscellaneous.
  • Accomplished this over three years.
  • Within Miscellaneous, senior Prior Authorization Pharmacist and outstanding performer in project management and client relations.
  • Patients were informed about medication side effects, contraindications, and benefits.
  • Prior Authorization Pharmacist with 16 years of successful quality assurance and vendor management experience.
  • Professional who is well-organized and respectful keeps a flexible schedule and adapts to changing business and customer needs.
  • Collaborative and customer-focused, with a track record of collaborating with multi-disciplinary teams to discuss medications and drug interactions.
  • Excellent communication skills, as well as a strong desire to educate patients about medication therapies.
  • Achieved results within 18 months.
  • In a busy pharmacy environment, highly adaptable Prior Authorization Pharmacist providing medical assistance and support to patients.

Accomplishments

  • Guided inter-department collaboration on a task force focused on insurer relations, achieving a 57% increase in successful prior authorization submissions over 6 months.
  • Implemented automated documentation tools that improved clinical documentation analysis accuracy by 39% and significantly reduced manual errors.
  • Documented and resolved framework which led to process.
  • Analyzed insurance claim trends and optimized submission processes, increasing authorization success rate by 58% within procedure.
  • Led weekly knowledge-sharing sessions with colleagues to address frequent claim rejections, boosting the department’s overall efficiency by 69%.
  • Developed prior authorization training materials for new hires, reducing onboarding time by 4 weeks while improving accuracy in authorization submissions.
  • Designed clinician-specific educational campaigns, which led to a 67% improvement in treatment plan adherence due to fewer medication rejections.
  • Created risk mitigation strategies for high-cost drug requests, minimizing financial exposure by 14 while improving customer satisfaction by 36%.
  • Resolved over 4 escalated cases with insurance providers, resulting in more than $16 savings for the hospital's pharmacy department in 2024.
  • Led a pilot program that automated parts of the prior authorization process, improving request accuracy by 66% and reducing time-to-approval by 5 hours.

Affiliations

  • Jaycees
  • Lions Club
  • American Pharmacists Association (APhA)
  • American Society of Health-System Pharmacists (ASHP)
  • Pharmaceutical Research and Manufacturers of America (PhRMA)
  • International Society for Pharmacoeconomics and Outcomes Research (ISPOR)
  • State Pharmacy Association North Carolina
  • Association for Supply Chain Management (APICS)
  • American Medical Informatics Association
  • American Society of Oncology Pharmacists

Certifications

  • Microsoft Certified Systems Engineer (MCSE)
  • Board Certified Cardiovascular Pharmacist (BCCP)
  • Board Certified Infectious Diseases Pharmacist (BCIDP)
  • Board-Certified Geriatric Pharmacist (BCGP)
  • Cisco Certified Network Associate (CCNA)
  • SHRM Senior Certified Professional (SHRM-SCP)
  • Certified Managed Care Pharmacy Specialist (CMCP)
  • Certified Public Accountant (CPA)
  • SHRM Certified Professional (SHRM-CP)
  • Certified Prior Authorization Specialist (CPAS)

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