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Katheryn Epling
Looking for a jobPharmacy Operations Specialist II
Pharmacy Operations Specialist II at Weight Watchers Clinic / Sequence who raised denial overturn rates to approximately 40% through payer-aligned appeal strategy.
United StatesPharmacy Operations Specialist II at Weight Watchers Clinic / Sequence
Experience
Pharmacy Operations Specialist II
Increased denial overturn rates to approximately 40% through payer-aligned appeal strategy and analysis of denial patterns. Redesigned appeals triage and workflows, served as an SME and mentor, and collaborated with engineering teams to improve PA and appeals operations.
Prior AuthorizationsAppealsDenialsPayer PolicyClinical DocumentationWorkflow OptimizationEscalation ManagementHIPAA complianceCoverMyMedsAvailitySurescriptsEpicSalesforceServiceNowZendesk
Pharmacy Representative
Managed 40-50+ daily cases involving prior authorizations, billing inquiries, and coverage determinations. Resolved denials and supported appeals through clinical documentation review and payer-policy interpretation.
Prior AuthorizationsAppealsDenialsClinical DocumentationPayer PolicyFormulary RequirementsInsurance SupportPatient Support
Pharmacy Benefits Specialist
Achieved 99% CSAT through patient advocacy and insurance navigation. Investigated pharmacy claims using adjudication data and NCPDP reject codes, and trained 3-5 new hires per cycle.
Pharmacy BenefitsInsurance NavigationClaims AdjudicationPrior AuthorizationsCOBReimbursementTrainingCSAT
Retention Specialist
Conducted 100+ outbound calls daily to support customer retention and account resolution. Managed high-volume accounts and a team of eight employees through coaching and operational guidance.
Customer RetentionOutbound CallsAccount ManagementTeam LeadershipProblem Solving
Education
Hartselle High School
Completed an Advanced Diploma from Hartselle High School in 2009.
Completed an Advanced Diploma from Hartselle High School in 2009.