Julie Khut
Dallas,TX
Summary
Experienced Field Reimbursement Manager with 15 years of expertise in the healthcare industry, specializing in reimbursement and serving as a liaison with specialty pharmacies. Proven track record in overcoming barriers to patient access by navigating insurance coverage complexities, reimbursement processes, and prior authorizations. Skilled in building collaborative relationships with healthcare providers and key stakeholders, providing education on product coverage and optimizing reimbursement opportunities for improved patient outcomes.
Overview
17
17
years of professional experience
1
1
Certification
Work History
Field Reimbursement Manager
CENCORA
09.2019 - Current
- Advise and assist healthcare entities in overcoming payer access and reimbursement issues to optimize patient access to FDA-approved pharmaceuticals
- Stay up-to-date with payer coverage policies, changes, and trends to provide accurate and timely reimbursement guidance to healthcare providers
- Educate providers on various product fulfillment pathways, such as physician buy and bill, retail pharmacy options, and specialty pharmacy services
- Possess specialized reimbursement knowledge within specific disease states, including gastroenterology, dermatology, neurology, and nephrology
- Collaborate with sales partners to identify trends and proactively educate offices to minimize access issues
- Serve as a subject matter expert on coding requirements and documentation guidelines related to specialty pharmaceuticals, providing guidance to healthcare providers on accurate coding practices
- Work closely with the reimbursement matrix team and third-party reimbursement support programs to assist healthcare providers with copay assistance programs, prior authorization support, claims denial management and tracking, health benefit verification, and clinical policy education.
Specialty Pharmacy Liaison
TUFTS MEDICAL CENTER
11.2017 - 09.2019
- Utilize multiple EMR systems to obtain treatment plans and patient demographics for insurance verification and authorization process
- Provide comprehensive prior authorization services, including insurance benefit investigation, copay assistance, foundation support, medication replacements, and insourcing the dispensing function of Specialty Medications
- Serve as a liaison between clinical pharmacists, coordinators, nurses, and healthcare providers to facilitate pharmacy prior authorizations, specialty drug medical prior authorizations (buy & bill), and appeal processes for specialty clinics, general medicine, and inpatient discharge
- Refer patient concerns requiring clinical interpretation to the appropriate provider (RPh, MD, RN, NP, PA)
- Coordinate medication access across various pharmacies including in hospital, retail, specialty, mail-order, and limited distribution pharmacies
- Facilitate access to internal and external IV infusion services
- Manage medication fulfillment processes including shipment coordination and inventory restocking
- Collaborate with nurses and MDs to ensure effective medication therapy management for patients with chronic illnesses through compliance monitoring and adherence support
- Train and mentor new staff members.
Clinical Pharmacy Technicia
BETH ISRAEL MEDICAL CENTER (BIDMC)
08.2016 - 11.2017
- Hospital-based primary care teaching practice provides care to over 41,000 patients.: adolescent, adult, and geriatric population
- Collaborate with a diverse healthcare team, including clinical pharmacists, pharmacy students, faculty physicians, internal medicine residents, nurse practitioners, nurses, social workers, community resource specialists, and support personnel to deliver comprehensive patient care
- Resolve complex prescription insurance issues such as formulary restrictions, insurance overrides, and quantity limits
- Assist in routine filling of prescription renewal requests, diabetic supplies, durable medical equipment, and route them to prescribing physicians following established practice protocols and guidelines
- Train new clinical staff members and serve as a knowledge resource for medication-related procedures, protocols, updates, and state/private insurance coverage information
- Access clinical records and process pharmacy prior authorizations for non-covered medications by providing necessary clinical information through phone calls, faxes, or online platforms like CoverMyMeds
- Communicate with patients and pharmacies regarding prescription prior authorization outcomes such as approvals, denials, medication clarifications, or changes to covered formulary preferred medications.
Certified Pharmacy Technician/Corporate Support
EATON APOTHECARY
03.2013 - 11.2015
- Resolve various third-party issues including rejects, early refills, vacation supply requests, quantity limits, and medication formulary changes
- Perform accurate counting, filling, and bottling of medication orders
- Monitor drug inventory levels for out-of-stock items and identify and remove expired drugs
- Process daily orders for multiple inventories (e.g., retail and 340B)
- Collaborate closely with clinic staff to ensure the proper dispensing of patient medications
- Assist the corporate trainer in resolving help desk tickets related to billing prescription issues, pricing (340B), coordination of benefits billing, and provide training support for current and new staff across multiple store locations
- Communicate with healthcare providers to notify them of medication prior authorizations requirements or recommend insurance formulary alternatives when necessary
- Provide excellent customer service by assisting customers with transactions and cash handling at the home store
- Address disputes regarding Medicare reimbursement rates by submitting online forms or through correspondence with purchase invoices.
Senior Laboratory Claims Processor
CALLOWAY LABORATORIES
04.2010 - 03.2013
- Conduct monthly audits of team claims to ensure accuracy and compliance with guidelines
- Provide training to new employees and offer support and guidance to existing team members as needed
- Utilize Excel to run and print Quick Claims, Insurance Verification, and Worker's Comp Daily charge reports, segmenting them based on team classification
- Manage and process patient account claims, ensuring accuracy and adherence to insurance guidelines
- Maintain shared documents, procedures, and protocols, updating them as necessary
- Continuously evaluate processes to identify opportunities for increased productivity and error reduction
- Supervise departmental duties for two teams: Claims Processor and Insurance Verification
- Serve as a proactive communicator and liaison with other groups and departments on a daily basis to resolve issues for the team
- Demonstrate expertise in intricate insurance plans, including state Medicaid plans serviced across all 50 states
- Cross-train in accounts receivable processes and provide assistance when needed.
Certified Pharmacy Technician
WALGREENS PHARMACY
09.2006 - 04.2010
- Collaborate with multiple pharmacists to manage prescription drug orders received through various channels such as voice mail, fax, e-faxes, and phone-ins
- Register new patients and update demographic information accurately
- Update insurance plans in the pharmacy system
- Process, fill, label, count, and package prescription drug orders promptly to ensure timely pick up by customers
- Resolve third-party rejects on an hourly basis to ensure smooth processing of claims and reimbursement
- Address customer issues related to uncovered drugs, refill requests, and vacation supply needs with empathy and efficiency
- Proactively contact doctor's offices to initiate prior authorization requests for medications when necessary
- Monitor inventory levels regularly and order medications as needed
- Ensure proper stock of supplies to support pharmacy operations.
Education
Medical Administration, AS / Completed 5 Semesters -
Monroe College
Bronx, NYHealth Service Administration, BBA/Expected 5/2025 -
Monroe College
VirtualSkills
- Analytical thinking skills aim at problem solving and solution
- Ability to communicate with vast group of professionals
- Has extensive knowledge in Microsoft Office Word, Excel, and PowerPoint
- Relationship Building
- Insurance Verification
- Denial Resolution
- Commercial and government payer knowledge
- HIPAA Compliance
Certification
- Certified Pharmacy Technician-ADV, 08/31/2025, 10020439
- Texas Registered Pharmacy Technician, 08/31/2025, 358696
Languages
Khmer
Native or Bilingual
Timeline
Field Reimbursement Manager
CENCORA
09.2019 - Current
Specialty Pharmacy Liaison
TUFTS MEDICAL CENTER
11.2017 - 09.2019
Clinical Pharmacy Technicia
BETH ISRAEL MEDICAL CENTER (BIDMC)
08.2016 - 11.2017
Certified Pharmacy Technician/Corporate Support
EATON APOTHECARY
03.2013 - 11.2015
Senior Laboratory Claims Processor
CALLOWAY LABORATORIES
04.2010 - 03.2013
Certified Pharmacy Technician
WALGREENS PHARMACY
09.2006 - 04.2010
Medical Administration, AS / Completed 5 Semesters -
Monroe College
Health Service Administration, BBA/Expected 5/2025 -
Monroe College