KIM PHILLIPS
Hilliard,OHIO
Summary
Detail-oriented LPN with exceptional communication and project management skills. Proven ability to handle multiple tasks effectively and efficiently in fast-paced environments. Recognized for taking proactive approach to identifying and addressing issues, with focus on optimizing processes and supporting team objectives. Solid clinical and administrative experience, including utilization review, prior authorization, case management and specialty pharmacy reimbursement.
Overview
12
12
years of professional experience
Work History
Pharmacy Prior Authorization Nurse
Quantum Health
07.2023 - Current
- Expedited urgent requests for prior authorization, ensuring timely access to critical medical treatments.
- Collaborated with healthcare providers to ensure accurate submission of required documentation for timely authorizations.
- Promoted a culture of continuous improvement within the Prior Authorization department by regularly reviewing processes and making recommendations for optimization.
- Provided exceptional customer service to both patients and healthcare professionals, addressing concerns related to the prior authorization process.
- Improved patient satisfaction by providing clear communication regarding insurance approvals and denials.
- Identified cost savings opportunities for site of care transitions.
QUALITY PRACTICE ADVISOR/LIAISON
Healthmap Solutions
01.2022 - 01.2023
- Data abstraction and account management
- Identified Care Gaps/Interventions for Chronic Kidney Disease patients-HEDIS/HCC Codes
CASE MANAGER/PRIOR AUTHORIZATION
CoverMyMeds
01.2019 - 01.2022
- Submitted prior authorizations and appeals for medications.
- Provided exceptional access and reimbursement support to providers and patients.
- Supported the patient access process by working with specialty pharmacies with reimbursement issues.
SCHOOL NURSE
Dublin City Schools
01.2018 - 01.2019
SR. REIMBURSEMENT ANALYST-Prior Auth
OSU-The James-Outpatient Pharmacy-Oncology
01.2016 - 01.2017
CARE REVIEW CLINICIAN/Case Manager
Molina Health Plan
01.2015 - 01.2016
PRIOR AUTHORIZATION NURSE
Buckeye Health Plan-Centene
01.2014 - 01.2015
Education
LPN DIPLOMA -
The School of Nursing At CVCC
Broadview Heights Ohio06-2005
Skills
- Prior Authorization
- Appeals
- Quality Measures
- Data Abstraction
- Benefits/Reimbursement
- Case Management
- Utilization Management
- Clinical Experience includes- Med/Surg, Pediatrics, Oncology, Geriatrics, Obstetrics, Nephrology and Ophthalmology
- Pharmacology
Timeline
Pharmacy Prior Authorization Nurse
Quantum Health
07.2023 - Current
QUALITY PRACTICE ADVISOR/LIAISON
Healthmap Solutions
01.2022 - 01.2023
CASE MANAGER/PRIOR AUTHORIZATION
CoverMyMeds
01.2019 - 01.2022
SCHOOL NURSE
Dublin City Schools
01.2018 - 01.2019
SR. REIMBURSEMENT ANALYST-Prior Auth
OSU-The James-Outpatient Pharmacy-Oncology
01.2016 - 01.2017
CARE REVIEW CLINICIAN/Case Manager
Molina Health Plan
01.2015 - 01.2016
PRIOR AUTHORIZATION NURSE
Buckeye Health Plan-Centene
01.2014 - 01.2015
LPN DIPLOMA -
The School of Nursing At CVCC
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