Karen Kyle
Summary
Senior Pharmacy Program Specialist with extensive experience in pharmacy benefits management, claims processing, and drug program oversight. Adept at improving operational efficiency and ensuring compliance with healthcare regulations. Skilled in facilitating effective communication between members and pharmacies to enhance service delivery.
Overview
22
22
years of professional experience
1
1
Certification
Work History
Senior Pharmacy Program Specialist
Providence Health Plan
Portland , OR
08.2021 - Current
- Enhanced pharmacy benefits claims processing and ensured compliance with health plan operations, leading to improved service delivery.
- Streamlined communication between members and pharmacies, significantly boosting operational efficiency.
- Provided comprehensive information on pharmacy benefits for Medicare, Medicaid, and commercial plans to optimize member understanding.
Managed prior authorization setups and reviews, ensuring timely and accurate processing for all plan members. - Handled customer service inquiries across various platforms, delivering exemplary support and resolution.
Certified Pharmacy Technician
Safeway
Astoria / Seaside / Beaverton / Mcminnville, OR
03.2004 - 08.2021
- Dispensed medications accurately to patients and healthcare providers.
- Assisted in managing inventory and restocking pharmacy supplies.
- Processed prescription orders using pharmacy management software.
- Provided customer service by answering medication-related inquiries.
- Ensured compliance with safety and regulatory standards in the pharmacy.
- Maintained clean and organized workspaces for efficient operations.
- Prepared medications for dispensing by counting, pouring, labeling, and verifying doses.
- Performed data entry for patient profiles, billing information and prescription orders into the pharmacy software system.
- Assisted in training new employees on pharmacy procedures.
- Received payment from customers and processed credit card transactions when necessary.
- Prepared prescription transfers to other pharmacies.
Education
Associate of Science - Fire Science
Clatsop Community College
Astoria, OR 05-2006
Skills
- Pharmacy management software proficiency
- Data entry accuracy
- Healthcare customer service
- Regulatory compliance understanding
- Conflict resolution
- Pharmacy benefits management
- Claims processing
- Drug program oversight
- Prior authorization review
- Pharmaceutical compliance
- Customer relationship management
- Detail orientation
- Problem solving
- Time management
- Effective communication
- Multitasking capacity
Certification
Certified Oregon Pharmacy Technician
Timeline
Senior Pharmacy Program Specialist
Providence Health Plan
08.2021 - Current
Certified Pharmacy Technician
Safeway
03.2004 - 08.2021
Associate of Science - Fire Science
Clatsop Community College