Kyle Wilkinson

• Served as primary pharmacy consultant for Bigfoot Biomedical, providing crucial pharmacy market access strategy guidance and support of pharmacy relations ensuring successful integration and launch of the pharmacy model
• Assumed the responsibilities of a Pharmacy Relations Manager following the launch of the specialty pharmacy model and facilitated feedback channels between KnippeRX and Bigfoot Biomedical
• Reduced outstanding accounts receivable balances through diligent follow-up and effective communication with stakeholders
• Solely managed Bigfoot's invoicing process by utilizing a suite of customized Salesforce reports to analyze data and construct accurate invoices, thereby securing a consistent revenue stream for the business
• Identified a demand for additional payment options among providers and successfully introduced a new payment capability, directly contributing to revenue growth
• Collaborated with cross-functional teams to develop strategies for optimizing the revenue cycle process
• Conducted thorough reviews of payor policies and offered recommendations to providers, ensuring adherence to best practices for claim submissions and maximizing reimbursement opportunities
• Represented Bigfoot Biomedical at the Association of Diabetes Care & Education Specialists (ADCES) Annual Conference 2023, educating providers on the features and advantages of Bigfoot Unity

• Utilized HCPs communication of adverse adjudication of claims as basis for creation of a company wide educational program to improve claim outcomes with major payors
• Institution of company wide educational program with partner billers & providers led to a measurable return of revenue flow & addressed stagnation of collections
• Mentor employees on claim submission best practices & coach team members to provide guidance to HCPs
• Oversees creation of claim submission guidance for over 200 clinics nationwide
• Monitor claim adjudication & policy update trends to anticipate potential future actions to take with insurers
• Lead initiatives to develop new approaches to streamline existing processes, reorganize work, implement new technologies & improve resource utilization with a focus on revenue flow
• Collaborate with revenue cycle leadership to address customer issues regarding invoices & claim submission
• Assist customers in understanding & reconciling invoices
• Deliver RCM & claim submission guidance to customers, as well as, provide necessary industry or functional insight
• Analyzes billing & account receivable reports, identifies trends, categories of aged receivables & provides feedback to account managers to improve results
• Analyze financial data to assist senior leadership with decision-making tools that will maximize income & improve the revenue cycle
• Monitor key billing/collection statistics & report senior management
• Perform root cause analysis on claim submission denials to provide customers with claim submission guidance to correct & prevent future errors
• Provide Quality Analysis & feedback to providers on medical records to ensure medical necessity is clearly documented
• Partner with other departments to drive continuous improvement & implement strategic decisions from senior leadership
• Communicate goals & manage workload through daily huddles with team, e.g. (Demand & Capacity)

• Primary consultant on all matters regarding claim submission guidance for both CMS and commercial payors
• Lead & coach payor relations team to improve performance, provide feedback & develop plans for skill development
• Provide strategic consulting sessions for providers on claim issues
• Maintain databases & Salesforce CRM system of payors & payor policies
• Maintain knowledge of all system, contractual, compliance standard & policy updates in relation to internal services
• Ad hoc assistance as a subject matter expert for questions & concerns from providers, billers & internal sales team
• Prepare & present PPT to represent business impacts including projected revenue & payor climates to CEO, CFO

• Utilized knowledge areas related to Claims, e.g. Network, Benefits, Authorizations, Provider Operations, Finance, Pharmacy
• Provided guidance on escalated payor claim issues & reported out on critical financial data
• Acted as consultant to providers & recommended course of action on issues, e.g. audit requests & overpayment notices
• Foster a culture of team work to build employee commitment & enthusiasm for the success of the team & the business
• Handled & resolved routine claim issues including denial of payment for provider services
• Reported on financial impact of negative claim submission outcomes & made recommendations for improvements to standard work flow processes
• Assisted in management of payor relations team
• Collaborated with legal team to create appeal letters for provider use & delivered end product to providers
• Review EOBs & remittances from provider offices
• Advise leadership on policy updates & make recommendations for improving claim submission guidance

Clinical Analyst IT/Duties

• Managed system-wide coordination of all medication use technology-based processes within hospital
• Acted as clinical informatics consultant to Nursing departments providing medication information for development of integrated medication-related system functionalities
• Effectively supervised access of 300 pharmacy, nursing & non-clinical staff to Meditech, Omnicell & Pyxis machines
• Unified pharmacy staff, nursing staff, vendors, & senior management through precise vertical & horizontal communications orally & in writing
• Coordinated with Clinical Pharmacist & Pharmacy Director, strategy & implementation of a large scale Meditech upgrade/expansion
• Collected, analyzed & monitored pharmacy data including quality, integrity & trends of drug & user information within automated med dispenser applications
• Collected & utilized data to increase workflow efficiency, accuracy & increased patient safety

Pharmacy Duties

• Designated Process Improvement Facilitator; recommended process improvements within & outside pharmacy
• Maintained relationships & communicated with vendors (Pfizer) effectively
• Developed master schedule for pharmacy staff & troubleshoot coverage issues
• Leader on special projects including deployment of pharmacy cost savings initiative plan
• Closely collaborated with staff to make necessary improvements to pharmacy storage based on feedback from The Join Commission & ensure compliance to Commission standards

• Executed & managed all purchasing activities hospital pharmacy - requisitions, purchase orders, price negotiation, creation of bar codes & receiving
• Participated in new employee onboarding process & training new employees (IV compounding, inventory ordering )
• Direct involvement in pharmacy interviewing & hiring activities
• Direct involvement with budgetary compliance by reducing costs & improving supply logistics
• Developed cost savings initiative focused on narcotics; reduced hospital costs by $300,000 in 2015 through alternative drug recommendations
• Key representative for pharmacy & hospital during Baldrige Performance Excellence Program onsite visit; participated in onsite interviews & assisted in tours of hospital
• Key member of special project in 2015 for creation of hospital employee orientation video to be used for on-boarding of new employees
• Staff meeting leader; regularly reported on inventory, shortages & pharmacy needs
• Maintained & enhanced direct vendor relationships with hospital (Pfizer, FFF, Westward Pharmaceuticals)

• Delivered patient medications to designated hospital floors; prepared & delivered medication carts to patients & nursing units
• Restocked Pyxis machines throughout hospital & supervised distribution compliance between nurses & patients
• Prepared sterile I.V. admixtures including TPN & PCA batching under a laminar flow hood for distribution to all hospital areas
• Regularly used Meditech, McKesson Med Carousel & Pyxis machines, including narcotic vault
• Refilled, loaded & unloaded medications in Pyxis; restocked operating case rooms, anesthesia Pyxis machines, & handled stock outs & outdates
• Properly cleaned & maintained pharmacy equipment including IV room & hoods
• Triaged nurse & doctor phone calls appropriately

• Provided assistance to registered pharmacist & pharmacy customers
• Supervised up to 10 pharmacy technicians & coordinated day-to-day assignments
• Provided excellent customer loyalty & generation of repeat/referral business
• Prepared medications such as emulsions, liquids & reconstituted antibiotics
• Answered questions & conducted follow ups with customers/healthcare providers
• Effectively resolved insurance rejections & other billing issues
• Created the pharmacy staff schedule & assisted with coverage for PTO/Holidays