Kimberly Sykes
Riegelwood,NC
Summary
Dynamic sales associate with extensive pharmacy experience, recognized for exceptional communication skills and a proven track record of timely task completion. Detail-oriented and committed to delivering high-quality service, consistently ensuring accuracy in all interactions. Strong collaborative abilities foster effective teamwork and enhance overall productivity. Passionate about contributing to team success while maintaining a customer-focused approach in a fast-paced environment.
Overview
4
4
years of professional experience
Work History
Prior Authorization Specialist
Novant Heart and Vascular
Wilmington, NC
06.2024 - Current
- Collaborated with physicians to obtain necessary clinical information for prior authorization submissions.
- Maintained thorough knowledge of insurance plan requirements, facilitating accurate and timely completion of authorization forms.
- Verified eligibility and compliance with authorization requirements for service providers.
- Analyzed medical records and other documents to determine approval of requests for authorization.
- Responded to inquiries from healthcare providers regarding prior authorization requests.
- Reduced turnaround time for prior authorization requests by utilizing electronic submission methods.
- Monitored pending cases closely, proactively following up on outstanding documentation needed for successful approval outcomes.
- Achieved high success rate in obtaining authorizations by effectively demonstrating medical necessity through comprehensive documentation and clear communication with insurance companies.
- Provided training to new staff members on the intricacies of various insurance plans and their specific prior authorization requirements.
- Tracked referral submission during facilitation of prior authorization issuance.
- Researched denied claims and contacted insurance companies to resolve these issues.
- Reviewed appeals for prior authorization requests and communicated with payers to resolve issues.
- Prepared and distributed denial letters, detailing reasons for denial and possible appeal measures.
- Advocated for patients by negotiating with insurance providers to cover necessary treatments not initially authorized.
- Improved patient outcomes by expediting authorization process for urgent and life-saving treatments.
- Coordinated with pharmacy staff to ensure timely dispensing of medications following authorization approval.
Pharmacy technician/DH
Walgreens pharmacy
Leland, NC
01.2022 - 06.2024
- Fill prescription, file insurance, enter in patient’s information, answer phone calls, and run cash register. I also stocked shelves when needed.
Sales Associate
Browns outdoors
Delco, NC
07.2022 - 12.2022
- Ran cash register, helped customers find products, stocked shelves
Education
Associates Degree - Business Accounting
Cape Fear Community College
01.2009
High School Diploma - undefined
Hoggard High School
01.2006
Skills
- Attention to detail
- Microsoft word
- ANS Pharmacy System
- Bookkeeping
- Exceptional communication
- Microsoft Excel
- Epic
- Cover my meds
- Onbase
Timeline
Prior Authorization Specialist
Novant Heart and Vascular
06.2024 - Current
Sales Associate
Browns outdoors
07.2022 - 12.2022
Pharmacy technician/DH
Walgreens pharmacy
01.2022 - 06.2024
Associates Degree - Business Accounting
Cape Fear Community College
High School Diploma - undefined
Hoggard High School