Summary
Overview
Work History
Education
Software
Timeline
Generic

Kimberly Sheffield

Account Management
Northglenn,CO

Summary

Obtain a position at a company where I can maximize my management skills, quality assurance, program development, and training experience. Utilize my education while increasing my overall pharmacy knowledge.

Overview

4
4
years of post-secondary education
10
10
years of professional experience

Work History

Admissions Specialist

DaVita Dialysis
Centennial, CO
01.2020 - Current
  • Respond professionally, promptly, and courteously to inbound calls, e-mails and faxed referrals and/or requests for treatment options.
  • Request placement and/or respond to inquiries regarding treatment options via outbound calls, e-mail, and/or other designated contacts.
  • Provided quick response and follow-up to patient inquires, including phone calls and emails to various outlets such as Dialysis Center, and Facility Administrators.
  • Assisted patients with admissions requirements and served as point of contact throughout admissions process.

Client Service Account Coordinator

WellDyneRx
Centennial, CO
08.2017 - 04.2019
  • Implemented business requirements of the client and translated them to specific system requirements.
  • Established repetitive and ongoing deliverables for the client including encounter data files, utilization reports, and issue logs.
  • Provided quick response and follow-up to client inquires, including phone calls and emails to various outlets such as client, TPA’s, patients, and pharmacies.
  • Conducted training to new team members along with cross team collaboration trainings.

Prior Authorization Technician

WellDyneRx
Lakeland, FL
07.2013 - 08.2017
  • Performed outreach to providers to obtain required documentation for prior authorization review and any additional information required.
  • Worked directly with retail pharmacies in processing, troubleshooting and adjudication of claims.
  • Answer calls from members and patient representatives inquiring of status of member prior authorizations.
  • Tracked referral submission during facilitation of prior authorization issuance.
  • Verified eligibility and compliance with authorization requirements for service providers.

Member Service Lead

WellDyneRx
Lakeland, FL
08.2010 - 08.2013
  • Worked in Member Service Department for full service mail order pharmacy and national pharmacy benefit manager.
  • Provided customer service/ management support including enrolling, placing orders, researching issues, verifying and respecting HIPAA guidelines.
  • Worked with local retail pharmacies and insurance providers to analyze, adjust, identify input to assist in claim processing.
  • Worked with various computer programs including all of Microsoft Office Suite.
  • Learned all internal systems and related service role duties to provide skilled team backup in handling customer demands.

Education

High School Diploma -

Bartow High School
Bartow, Fl
08.1995 - 05.1999

Pharmacy Technician Training -

Pharmacy Technician University
Online
09.2013 - 10.2013

Software

Microsoft Outlook

RxClaim

ServiceNow

Office 365

Timeline

Admissions Specialist

DaVita Dialysis
01.2020 - Current

Client Service Account Coordinator

WellDyneRx
08.2017 - 04.2019

Pharmacy Technician Training -

Pharmacy Technician University
09.2013 - 10.2013

Prior Authorization Technician

WellDyneRx
07.2013 - 08.2017

Member Service Lead

WellDyneRx
08.2010 - 08.2013

High School Diploma -

Bartow High School
08.1995 - 05.1999

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Kimberly SheffieldAccount Management