Felicia Villalobos
Brighton,CO
Summary
Proven leader in pharmacy operations, adept at enhancing workflow efficiencies and ensuring FDA and HIPAA compliance. At UCHealth University of Colorado Hospital, I spearheaded quality improvement initiatives, reducing authorization denials by 30%. My motivational leadership and expertise in insurance reconciliation have consistently improved patient care and service delivery.
Overview
1
1
year of professional experience
Work History
Specialty Pharmacy Liaison
UCHealth University of Colorado Hospital
Aurora, CO
08.2024 - Current
- Proofread documents carefully to check accuracy and completeness of all paperwork.
- Coordinated with healthcare providers to gather necessary patient information for prior authorization requests.
- Contacted insurance companies to obtain necessary preauthorizations needed for upcoming tests and procedures.
- Coordinated with pharmacy staff to ensure medications requiring prior authorization are processed correctly.
- Collaborated with internal staff members to resolve discrepancies or issues related to prior authorizations.
- Followed up on pending prior authorization requests to ensure timely processing.
- Provided accurate information to all parties, including patients, insurance providers, healthcare staff and office personnel by using effective written and verbal communication skills.
- Educated healthcare providers on prior authorization requirements and insurance formulary changes.
- Coordinated resolutions for issues and appealed denied authorizations.
- Developed and implemented process improvements to enhance efficiency and accuracy of prior authorization workflows.
- Analyzed trends in authorization denials and reported findings to management for quality improvement initiatives.
- Maintained positive working relationship with fellow staff and management.
- Updated reference materials with Medicare, Medicaid and third-party payer requirements, guidelines, policies and list of accepted insurance plans.
Pharmacy Liaison
Shields Health Solutions
Denver, Colorado
12.2023 - 08.2024
- Transmitted claims to insurance companies for payment and reconciled EOBs.
- Led and performed aspects of pharmacy operations, delivering continuous quality products and services in alignment with physician orders and prescriptions.
- Monitored the performance of pharmacies to ensure adherence to established policies and procedures.
- Coordinated with other department supervisors to ensure smooth workflow and project alignment.
- Greeted customers and answered questions regarding personal medications or over-the-counter pharmacy products.
- Proofread documents carefully to check accuracy and completeness of all paperwork.
- Coordinated with healthcare providers to gather necessary patient information for prior authorization requests.
- Contacted insurance companies to obtain necessary preauthorizations needed for upcoming tests and procedures.
- Coordinated with pharmacy staff to ensure medications requiring prior authorization are processed correctly.
- Collaborated with internal staff members to resolve discrepancies or issues related to prior authorizations.
- Assisted healthcare providers with appeals for denied authorizations, including gathering additional information and documentation.
- Maintained confidential patient documentation to prevent data compromise and comply with HIPAA regulations.
- Applied knowledge of Medicare, Medicaid and third-party payer requirements utilizing on-line eligibility systems to verify patient coverage and policy limitations.
- Reviewed and processed prior authorization requests for medical procedures and medications according to established guidelines.
- Reviewed prior authorization requests to ensure accuracy and completeness of required information.
- Scheduled patient appointments, diagnostic specialty appointments, tests and procedures.
- Educated healthcare professionals on how to properly submit a request for pre-authorization.
Education
Bachelor of Science - Criminology
Regis University
Denver, CO01-2004
Associate of Applied Science - Paralegal
Community College of Denver
Denver, CO08-2000
Skills
- Drug safety
- FDA compliance
- Insurance reconciliation
- Billing support
- Drug utilization review
- Regulatory compliance
- FDA and HIPAA compliance
- Answering customer questions
- Confidentiality and HIPAA
- Quality assurance and control
- Leadership qualities
- Motivational leadership
References
References available upon request.
Timeline
Specialty Pharmacy Liaison
UCHealth University of Colorado Hospital
08.2024 - Current
Pharmacy Liaison
Shields Health Solutions
12.2023 - 08.2024
Bachelor of Science - Criminology
Regis University
Associate of Applied Science - Paralegal
Community College of Denver
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