AMY KING
Burnsville,MN
Summary
Accomplished professional with over 15 years of expertise in the PBM industry. Skilled in service delivery management with a strong client-facing background. Talented in assessing client needs and developing solutions to promote business opportunities. Offering exemplary client relationship building prowess. Known for being detail-oriented, fostering employee development, and leveraging well-developed problem-solving and critical thinking skills to drive operational excellence and client success.
Overview
24
24
years of professional experience
Work History
Manager, Service Delivery
RxSense
07.2021 - Current
- Accountable for relationship development and service satisfaction between RxSense and is business partners starting in the implementation phase and throughout the life cycle of the RxSense-Client relationship
- Manages client expectations, responds to inquiries, isolates problems, troubleshoots issues, implements solutions, and assess client requirements with accuracy
- Collaborates with clients and account management team to identify client needs and propose solutions to meet client and company objectives
- The point of contact for day-to-day management of service requests
- Maintains strong internal relationships and contacts within the company that are supportive of the achievement of client service requirements including attainment of performance guarantees and minimization of performance penalty expense
- Initiates and lead interactions with internal peers and business partners to sustain the progression of issue resolution
- Assist efforts to continuously improve by assuming responsibility for identifying and bringing to the attention of responsible entities operations problems and/or inefficiencies
Manager, Network Management Provider Relations
Prime Therapeutics LLC
02.2007 - 07.2021
- Provide work direction to resolve problems, monitor performance, and provide mentorship, coaching and development for team members to support department objectives
- Developed quantitative and qualitative performance measures and ensure accountability for department objectives and deliverables
- Develop and maintain relationships with internal and external stakeholders regarding the management and development of Network Management strategies
- Serve as liaison between Prime and pharmacies for applicable legal correspondence
- Oversee and approve new key processes the team develops as part of continuous improvement and develop strategies to achieve world class status in operational effectiveness and pharmacy and client experience while ensuring compliance and adherence to all regulatory guidelines
- Accountable for analysis of network vendor performance related to pharmacy relation issues; identifying trends and establishing action plans
- Serve as an escalation point for pharmacy complaints, issues or grievances; collaborate with internal stakeholders or leadership to determine appropriate solutions and facilitate resolution with appropriate parties.
- Increased team productivity by implementing streamlined processes and effective communication strategies.
Manager, Operations
Prime Therapeutics LLC
11.2017 - 09.2020
- Oversee project work, ensuring assigned staff has a solid understanding of the assigned testing and documentation scope, deliverables and deadlines for each project
- Manage a project testing dashboard to measure and report on overall testing status
- Manage escalated project issues while leading delivery of solutions to meet client needs
- Develop frameworks for Claims Analyst accountabilities, including repeatable processes and templates, to promote standardization and continuity of deliverables
- Mentor and develop staff; provide work direction and assign staff to projects based on ability, knowledge, capacity and development goals
- Provide leadership updates on a portfolio of projects as the business owner or capability lead.
Claims Analyst, Sr., Claims Product Services
Prime Therapeutics LLC
04.2015 - 11.2017
- Lead department projects
- Serve as an escalation point to internal and external departments/clients on supported products
- Develop operational procedures, documentation, and training
- Act as a subject matter expert (SME) on system functionality
- Create joint test plans, test suites, and completion of UAT
- Translate complex details of claim system capabilities to the business or non-technical audiences
- Identify and document system defects related to products supported.
Product Operations Analyst
Prime Therapeutics LLC
12.2012 - 03.2015
- Mentor project team members while overseeing requirements and testing, provide assistance with technical design and requirements, and coordinate with internal and external partners to implement special projects for Health Insurance Marketplace clients
- Serve as the escalation point for Product Operations Specialists and Sr. Specialists
- Mentor and train team members on system capabilities and process knowledge
- Lead department projects as assigned
- Serve as the Subject Matter Expert on cross functional and department projects including implementations and fast track projects providing User Acceptance Testing.
Formulary Operations Analyst
Prime Therapeutics LLC
11.2011 - 12.2012
- Maintain formulary databases in Formulary Workplace
- Analyze Medi-Span weekly roll-ins in accordance each client’s Admin Action Policy
- Prepare quarterly client formulary publications
- Prepare ad hoc reports/requests/information including the Multi-client Formulary and database NDC lists.
Certified Pharmacy Technician
Prime Therapeutics LLC
02.2007 - 11.2011
- Process prior authorization requests for multiple clients
- Process coverage determinations, reconsiderations, and high dollar overrides
- Customer Service for the Member Research Team, contact center, pharmacies, physicians, etc.
Senior Liaison
BLUE CROSS AND BLUE SHIELD OF MN
08.2002 - 01.2005
- Train/Mentor new Liaisons
- Special Project Team
- Process member, provider and regulatory appeals
- Prepare and present 2nd level appeals to the Corporate Appeals Committee.
Customer Service Representative/Claims Processor
BLUE CROSS AND BLUE SHIELD OF MN
12.1999 - 08.2002
- Customer Service for National Accounts
- Claims and Pricing processor for Government Programs.
Education
Nursing Program – Registered Nursing Assistant, Nursing/Clinical courses, General Education courses -
Rochester Community College
Certificate, Pharmacy Technician -
PTCB– Pharmacy Technician Certification Board
01.2009
Skills
- Issue Resolution
- Client Support
- Complex Problem-Solving
- Team Leadership
- Cross-functional Teamwork
- Conflict Resolution
- Customer Relationship Management
- Data Analysis
- Risk Mitigation
- Critical Thinking
- Communication
Timeline
Manager, Service Delivery
RxSense
07.2021 - Current
Manager, Operations
Prime Therapeutics LLC
11.2017 - 09.2020
Claims Analyst, Sr., Claims Product Services
Prime Therapeutics LLC
04.2015 - 11.2017
Product Operations Analyst
Prime Therapeutics LLC
12.2012 - 03.2015
Formulary Operations Analyst
Prime Therapeutics LLC
11.2011 - 12.2012
Manager, Network Management Provider Relations
Prime Therapeutics LLC
02.2007 - 07.2021
Certified Pharmacy Technician
Prime Therapeutics LLC
02.2007 - 11.2011
Senior Liaison
BLUE CROSS AND BLUE SHIELD OF MN
08.2002 - 01.2005
Customer Service Representative/Claims Processor
BLUE CROSS AND BLUE SHIELD OF MN
12.1999 - 08.2002
Nursing Program – Registered Nursing Assistant, Nursing/Clinical courses, General Education courses -
Rochester Community College
Certificate, Pharmacy Technician -
PTCB– Pharmacy Technician Certification Board
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