Kimberly Aldridge
Shingletown,CA
Summary
Personable and dedicated with keen eye for detail and proactive approach. Possesses foundational knowledge in pharmaceutical terminology and drug interactions, along with excellent organizational and data entry skills. Committed to ensuring accurate medication dispensing and enhancing patient care.
Overview
11
11
years of professional experience
1
1
Certification
Work History
Pharmacy Technician
Blue Shield Of California/Spectraforce (Contract)
04.2024 - 08.2024
- Take inbound calls, Coordinate, assist in, and support implementation of procedures and guidelines for the drug prior authorization program
- Evaluate prior authorization requests based on medication policy and operational principles and criteria, escalate to appeals and grievances when necessary
- Provide drug usage history and other pertinent pharmacy benefit related inquiries to internal business partners to assist in case specific reviews and drug evaluations
- Communicate with the physician, physician's office staff, pharmacies, and internal business partners to assist with accurate and efficient resolution of pharmacy benefit inquiries
- Clearly communicate formulary alternatives and prior authorization criteria, and discusses pharmacy benefit coverage when required
- Research appeals and grievance and submit PA for them when needed
- Use ICD 10 and CPT when inputting Prior Authorizations
- Verify eligibility
- MS Outlook
Clinical Pharmacy Technician/Appeals Grievance
Oscar Health/Medix (Contract)
09.2022 - 04.2023
- Determining eligibility and screening incoming pharmacy prior authorization requests for all required documents, escalate to appeals and grievance when needed
- Preparing, organizing, and distributing pharmacy prior authorization requests for review by pharmacist/physician and responding to pharmacist/physician requests for additional information
- Verifying insurance coverage
- Learning and using Oscar and vendor tools to create, process, and properly track pharmacy prior authorization and appeals and grievance requests
- Collecting relevant medical information (via telephone, fax, and portal) and applying the appropriate PA criteria
- Meeting required decision-making timeframes, including promptly triggering escalation for cases requiring pharmacist review
- Clearly documenting all communication and decision-making, ensuring a peer could easily reference and understand your decision
- Communicating oral and written prior authorization outcome notifications that comply with standards and requirements for timeliness, content and accuracy
- Demonstrating the highest level of professionalism, accountability, and service in your interactions with Oscar teammates, customer service, providers, and members
- Participating in quality improvement activities as requested
- Developing a working familiarity with applicable regulatory and accreditation requirements
- Providing support on regulatory audits and quality accreditation surveys, as needed
- Supporting the team prepare for expansion into new markets, as needed
- Acute attention to detail
- Willingness to grow, learn, and work as a member of a cross-functional team
- Strong quantitative analysis skills, Strong verbal and written communications
- Handled appeals and grievances accordingly, researched cases
- MS Outlook
Appeals and Grievance Coordinator
OptumRX/Total Med (Contract)
12.2022 - 03.2023
- Using established criteria and guidelines, the pharmacy technician receives and processes prior authorization requests made by providers and members for medications not inherently covered on a member's prescription drug plan
- Resolve appeal and grievance issues and complaints in a timely manner
- Use CPT and ICD -10 coding
- Performs other duties as assigned by management
- Handles inbound phone requests and gathers information for appeals and grievances for member data to provide information for Pharmacist consultations
- Verify eligibility
- Research appeals and grievance with state and federal regulations
Clinical Pharmacy Technician
Amerit Consulting/ Magellan Health (Contract)
01.2022 - 09.2022
- Responsibilities include evaluating & authorizing approval of prior authorization pharmacy requests, and appeal's from prescribers received by telephone and/or EPA
- Determines appropriateness for medications
- Communicates decision to physicians, physician's office staff, medical management staff and/or pharmacists
- Use ICD-10 and CPT for criteria on Prior Authorizations
- Research, resolves, and documents prior authorization outcomes in pharmacy system
- Communicates selected prior authorization criteria, pharmacy benefit coverage and formulary alternatives to physicians, physician's office staff, medical management staff and/or pharmacists
- Escalates requests to Pharmacist when request requires extensive clinical review or denial
- Research, resolves, and documents physician or client inquiries and grievances and provides verbal or written results to client, prescriber, provider and/or management
- Verifies member information and inputs data for the pharmacists
- Educates members on pharmacy-based rules related to prescriptions and medication resources or assistance programs
- Processes prior authorization requests from physicians' offices and ensures compliance with Medicare requirements; informs relevant parties of all prior authorization determinations
- Provides resolution to grievances and appeals issues
- Maintains record keeping of prior authorizations, rebates, and monthly reports
- Handled Appeals when necessary
EHR Trainer MHS Genesis
MedSys Group
03.2021 - 07.2021
- I implement, administer, and evaluate electronic health records training and technical assistance activities for assigned VA contracts
- The position possesses and applies a comprehensive knowledge across key tasks and high impact assignments as related to Electronic Health Record (EHR) training
- May evaluates performance results and recommend changes affecting short-term project growth and success
- Deliver training on site and or virtually
- Cerner certified in Registration and Scheduling track
- Project put on hold due to Covid
Outpatient Pharmacy Technician
Department of Air Force
04.2020 - 09.2020
- Performs duties involved in all facets of outpatient medication distribution which includes use of automation for prescription filling and mailing
- Assists veterans with processing of medication refill requests, address changes, and missing medications
- Stores and documents medication waiting for destruction
- Uses technology to review the status of medications being processed, location of completed medications, and must possess knowledge of automated devices to assist with troubleshooting and problems
- Compounds and/or reconstitutes oral and external non-sterile medications not otherwise available from manufacturers in a safe and effective manner
- Operates and maintains pharmacy automation daily during times of heavy workload
- Responsible for stock replenishment of automated dispensing cabinets (ADCs) assigned to the Outpatient Pharmacy
- Closed Pharmacy due to COVID
Clinical Systems Trainer/Lead Trainer/MHS Genesis
Right Factor Consulting Group
07.2019 - 12.2019
- Assist in the development and/or revision of clinical application systems and lesson plans
- Provide lesson plans, course outlines, and classroom materials to support both on AHLTA and CHCS applications
- Also train on other various clinical applications
- Utilize a variety of instructional technologies (e.g
- Audiovisual equipment, computer assisted instruction, etc.), training equipment (e.g
- Computer workstations)
- Maintain records of training, consulting, and troubleshooting activities; developing statistical reports as needed
- Knowledge of health care environment for the delivery of classroom instruction on clinical information systems
- Basic understanding of automated data processing concepts necessary in order to communicate with system users and identify changes in the system or hospital clinical environment that may affect training
- Knowledge of educational techniques and training methodologies for delivery of classroom instruction using clinically related software applications
- Knowledge of electronic health system applications such as MHS GENESIS, Cerner, Joint Legacy Viewer (LV), military legacy systems such as AHLTA or other commercial electronic health record systems
- Knowledge of The Joint Commission (TJC) guidelines, recommendations, and patient safety goals
- Basic understanding of clinical business process flow used within clinical settings to train where clinical documentation supports such initiatives
- Maintain training logs on military personnel
- Lead trainer, responsible for 3 other trainers
- Helped with MHS Genesis
Referral Coordinator (Temp)
Signature Healthcare
02.2019 - 07.2019
- Work with military and dependents on processing referrals
- Following up on doctors notes, making packets to send to appropriate medical facilities
- Utilized CHCS and AHLTA to perform daily duties
- Experience in DOD rules and regulations in the healthcare system
- Followed up on referrals with various doctors offices in the Tricare network
- Always showed empathy for patients and always practiced HIPPA
- Performed basic clerical duties as needed
Pharmacy Technician
Dependable Health
01.2017 - 04.2019
- Working with military personnel filling medications
- Travel to outlining clinics to help when needed
- Use CHCS, GSL, and Pk2 programs daily
- Practice HIPAA daily
- Check for drug interactions when filling medications
- Process medical claims and followed up on Prior authorization to ensure they were approved
- Experience in various healthcare programs to include Tricare and experience of regulations
- Experience of processing claims
Inpatient Pharmacy Technician (Travel)
Holy Spirit Health System
10.2017 - 12.2017
- Working with Pharmacists to fill orders that print throughout the day
- Watched for STAT labels and filled very quickly
- Filled cart fills for all the floors to deliver to all the in the afternoon
- Ran EXP machine to repack medicine and also filled strips that went into the cart fills
- Compounded and reconstituted oral liquid such as Amoxicillin and Vancomycin
- Pulled Narcs when needed and I also stocked Omnicell on all the floors in the hospital
- Used Epic computer systems to perform daily duties
Certified Pharmacy Technician
Dependable Staffing
06.2016 - 03.2017
- Working with military personnel filling medications
- Travel to outlining clinics to help when needed
- Use CHCS, GSL, and Pk2 pharmacy programs daily
- Practice HIPAA daily
- Check for drug interactions when filling medications
- Process medical claims and followed up on Prior authorization to ensure they were approved
- Assisted in training new pharmacy technicians
- Experience in various healthcare programs to include Tricare and DOD regulations
- Experience of processing claims and prior authorizations
Pharmacy Technician/Clinical Technician
Optum
02.2014 - 05.2016
- Worked closely with WTU soldiers to make sure they had the medicine they needed
- Help educate patients about their INR levels
- Worked with HUMANA and Tricare processing medication claims and prior authorizations for military personnel
- Protect the security of medical records to ensure that confidentiality is maintained
- Kept SDR records and made sure they were up to date
- Monitored Polypharmacy records
- Review records for completeness, accuracy, and compliance with regulations
- Retrieve patient medical records for physicians, technicians, or other medical personnel
- Release information to persons or agencies according to regulations
- Process and prepare business or government forms
- Receive written prescription or refill requests and verify that information is complete and accurate
- Establish or maintain patient profiles, including lists of medications taken by individual patients
- Maintain proper storage and security conditions for drugs
- Answer telephones, responding to questions or requests
- Pre-pack bulk medicines, fill bottles with prescribed medications, and type and affix labels
- Assist customers by answering simple questions, locating items, or referring them to the pharmacist for medication information
- Supply and monitor robotic machines that dispense medicine into containers and label the containers
- Establish or maintain patient profiles, including lists of medications taken by individual patients
- Experience in various healthcare programs to include Tricare, Medicare
Education
High school diploma or GED -
WT Ellis
Marysville, CAMedical Billing & Coding -
Penn Foster Career School
Scranton, PA01.2026
Associate of Applied Science - Health Information Management
Penn Foster College
Scottsdale, AZ01.2026
Skills
- Computer skills
- Office equipment
- Billing
- Inventory
- Customer Service
- Data Entry
- Typing
- Time Management
- Microsoft Office
- Microsoft Word
- Outlook
- Word
- Scheduling
- Medical Records
- Training
- EMR
- Team Building
- Insurance Verification
- Multi-line phone systems
- Medical office experience
- Cerner
- Leadership
- Management
- Medical Terminology
- Medicare
- DME
- Anatomy Knowledge
- Microsoft Excel
- EMR systems
- Medical scheduling
- Microsoft Outlook
- EHR systems
- ICD-10
- Clerical experience
- Communication skills
- Pharmacy Technician Experience
- Supervising experience
- Clinic
- Healthcare management
- Training & development
- Medical administrative support
- Medical Coding
- Medical receptionist
- Medical billing
- Administrative experience
- Cash register
- Insurance verification
- Confidentiality and HIPAA
- Workflow optimization
Certification
- PTCB Certification, 12/30/24
- ServSafe
- Pharmacy Technician Certification
Personal Information
Authorized To Work: Yes
Timeline
Pharmacy Technician
Blue Shield Of California/Spectraforce (Contract)
04.2024 - 08.2024
Appeals and Grievance Coordinator
OptumRX/Total Med (Contract)
12.2022 - 03.2023
Clinical Pharmacy Technician/Appeals Grievance
Oscar Health/Medix (Contract)
09.2022 - 04.2023
Clinical Pharmacy Technician
Amerit Consulting/ Magellan Health (Contract)
01.2022 - 09.2022
EHR Trainer MHS Genesis
MedSys Group
03.2021 - 07.2021
Outpatient Pharmacy Technician
Department of Air Force
04.2020 - 09.2020
Clinical Systems Trainer/Lead Trainer/MHS Genesis
Right Factor Consulting Group
07.2019 - 12.2019
Referral Coordinator (Temp)
Signature Healthcare
02.2019 - 07.2019
Inpatient Pharmacy Technician (Travel)
Holy Spirit Health System
10.2017 - 12.2017
Pharmacy Technician
Dependable Health
01.2017 - 04.2019
Certified Pharmacy Technician
Dependable Staffing
06.2016 - 03.2017
Pharmacy Technician/Clinical Technician
Optum
02.2014 - 05.2016
High school diploma or GED -
WT Ellis
Medical Billing & Coding -
Penn Foster Career School
Associate of Applied Science - Health Information Management
Penn Foster College
- PTCB Certification, 12/30/24
- ServSafe
- Pharmacy Technician Certification
Similar Profiles
Elizabeth BelmontesElizabeth Belmontes
Enrollment Processor Specialist at Spectraforce (Blue Shield of California)Enrollment Processor Specialist at Spectraforce (Blue Shield of California)
Leah MoultrieLeah Moultrie
Clinical Pharmacy Technician at Blue Cross And Blue Shield Of Michigan (Contract)Clinical Pharmacy Technician at Blue Cross And Blue Shield Of Michigan (Contract)
Deja ShawDeja Shaw
Provider Enrollment Analyst at Blue Cross & Blue Shield of SC - Contract RoleProvider Enrollment Analyst at Blue Cross & Blue Shield of SC - Contract Role