KIMBERLY HOTZ
WAVERLY,United States
Summary
Efficient professional with 22 years of pharmacy experience. Productive and diligent with passion for resolving discrepancies through attention to detail and creative problem-solving. Passionate about perpetuating company values through impeccable work ethic and drive.
Overview
23
23
years of professional experience
1
1
Certification
Work History
Field Access and Reimbursement Specialist
Syneos Healthcare
06.2024 - Current
- Provide speaker and educational programs to healthcare staff on access and reimbursement issues
- Co-lead of ERG Healthcare committee assisting healthcare professionals transitioning into the pharmaceutical industry
- Provided exceptional customer service when responding to patient inquiries about reimbursement status and procedures.
- Supported company objectives by maintaining compliance with all relevant state and federal regulations governing medical billing practices.
- Advanced internal communication channels by sharing best practices among colleagues, fostering an environment of continuous learning and improvement.
- Maintained comprehensive knowledge of healthcare billing practices, staying current on industry updates and changes in regulations.
- Identified trends in reimbursement denials, recommending process improvements to minimize future occurrences.
- Contributed to increased team productivity by consistently meeting or exceeding individual processing goals.
- Maintained patient confidentiality by adhering to strict HIPAA guidelines when handling sensitive information.
- Followed up on denied and unpaid claims to resolve problems and obtain payments with over 90% approval rate
- Guided office staff on how to effectively complete prior authorization forms and appeals documentation to achieve positive results.
Clinical Supervisor
CVS Caremark/Aetna Medicare
01.2024 - 06.2024
- Managed the department to provide high-quality delivery of work to support the Medicare Part B (medical benefit) team
- Collaborated with multidisciplinary teams to coordinate care for clients with complex needs, ensuring comprehensive support was provided across all domains of life functioning.
- Enhanced team collaboration through regular staff meetings, case conferences, and training sessions.
- Served as a liaison between clinical staff and administration to address concerns and optimize workflows.
- Improved patient outcomes by implementing evidence-based treatment plans and clinical interventions.
- Lead and directed team of 20 clinical personnel and support staff.
Clinical Prior Authorization Pharmacist
CVS Caremark/Aetna Medicare
10.2017 - 01.2024
- Reviewed prior authorization requests for specialty medications and rare disease states including gene therapy medications and chemotherapy regimens
- Member of Denial team, Chemotherapy team and Subject Matter Expert team
- Gathered clinical information and applied proper medical necessity, guidelines, policies, and procedures from evidence-based guidance
- Preformed B v D reviews to differentiate between pharmacy and medical benefits
- Subject medication expert who aided with the pharmacist’s prior authorization inquiries on complex issues
- Aided in medication pieces of training for pharmacists and technicians
- Aided supervisor with scheduling needs and worked closely with Resource Planning
- Aided supervisor in various delegated projects aligning Part B and Part D departments
- Knowledgeable in CMS regulations, Drug Compendia, Medicare & Commercial Insurance, NCCN, and Microsoft
- Enhanced pharmacy operations through accurate and timely completion of medication therapy management interventions.
- Improved patient outcomes by efficiently reviewing and processing prior authorization requests for medications.
- Optimized workflow efficiency by effectively prioritizing tasks during high-volume periods or staffing challenges.
- Collaborated with interprofessional healthcare teams to develop individualized treatment plans for patients with complex medical conditions requiring specialized drug therapies.
- Participated in ongoing professional development opportunities, ensuring a strong foundation of knowledge in evolving pharmaceutical practices.
- Supported continuous quality improvement initiatives within the pharmacy department by participating in regular audits and reviews of processes and procedures.
- Provided exceptional customer service to both internal and external clients, fostering positive relationships throughout the healthcare system.
Long Term Care Consultant Pharmacist
Omnicare
03.2016 - 10.2017
- Researched issues and took appropriate action to resolve issues within turnaround time requirements and quality standards.
- Documented activities and progress in electronic medical record per defined policy and procedures.
- Maintained strict confidentiality and adhered to ethical guidelines in all aspects of care consultations.
- Implemented evidence-based practices for effective care coordination across multiple settings within the healthcare industry.
Medication Therapy Management Pharmacist
Case Haub Consulting
03.2016 - 10.2017
- Provided medication therapy management through comprehensive medication reviews to improve medication therapy
- Reviewed patient's medications for adherence monitoring, cost-effective interventions, preventing medication errors and adverse events
- Developed strong relationships with healthcare providers to optimize patient care and medication adherence.
Inpatient and Reconciliation Pharmacist
Unity Point Hospital
09.2013 - 03.2016
- Responded to medical codes in the emergency department and helped with medications in code carts
- Provided medication reconciliation to ensure the exact list of medications at admission, transfer, and discharge of patients for transition of care
- Checked hospital orders and showed ability in IV compounding and Chemotherapy orders
- Developed strong relationships with healthcare providers to optimize patient care and medication adherence.
- Educated patients about possible drug interactions and gave special administration instructions.
Retail Pharmacist (Staff and Manager)
Walmart Pharmacy
07.2002 - 09.2013
- Managed Pharmacy Support Staff by balancing different assignments including daily functions, employee reviews, and pharmacist/technician scheduling
- Collaborated with store management team members on merchandising initiatives, boosting sales of non-prescription products.
- Educated patients about possible drug interactions and gave special administration instructions.
- Improved patient care by providing accurate medication information and counseling services.
- Ordered and sold medication and other stock.
- Developed strong relationships with customers by addressing their concerns and providing personalized service.
Education
Doctor of Pharmacy - Pharmacy
Drake College of Pharmacy
Des Moines, IA01.2002
Bachelor of Arts - Chemistry
Wartburg College
Waverly, IA01.1998
Skills
- Problem solving
- Organization skills
- Written and Oral Communication
- Formulary Management/Managed Care
- Buy & Bill
- Drug Utilization Review
- Prior Authorization/Appeals
- Medicare
- Peer to Peer Consults
- Knowledgeable in Microsoft Office, CMS literature and Drug Compendia
- HCPCS coding/ICD-10 coding
- Claims processing
- Microsoft office
- Insurance verification
- Denial management
- Appeals handling
Certification
- Registered Pharmacist with Iowa Board of Pharmacy
- ACMA Prior Authorization Certified Specialist (PACS)
Timeline
Field Access and Reimbursement Specialist
Syneos Healthcare
06.2024 - Current
Clinical Supervisor
CVS Caremark/Aetna Medicare
01.2024 - 06.2024
Clinical Prior Authorization Pharmacist
CVS Caremark/Aetna Medicare
10.2017 - 01.2024
Long Term Care Consultant Pharmacist
Omnicare
03.2016 - 10.2017
Medication Therapy Management Pharmacist
Case Haub Consulting
03.2016 - 10.2017
Inpatient and Reconciliation Pharmacist
Unity Point Hospital
09.2013 - 03.2016
Retail Pharmacist (Staff and Manager)
Walmart Pharmacy
07.2002 - 09.2013
Bachelor of Arts - Chemistry
Wartburg College
Doctor of Pharmacy - Pharmacy
Drake College of Pharmacy
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