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Kristen Sherman

@kristensherman

Message

Pharmacy operations leader specializing in specialty pharmacy, claims, and patient advocacy.

United States

Message

What I'm looking for

I seek a senior operations role in pharmacy or specialty pharmacy with patient-focused culture, opportunities to lead teams, improve workflows, and ensure regulatory/compliance excellence.

I am a pharmacy operations professional with 20+ years of experience across specialty pharmacy, PBM operations, claims analysis, benefits investigation, prior authorizations, denials management, and patient advocacy. I bring strong supervisory experience (10+ years), attention to detail, and a focus on treatment adherence and positive patient outcomes.

In my current role I analyze prescription claim data, ensure adjudication aligns with plan and CMS requirements, identify and correct discrepancies, participate in audits, and perform end-to-end and regression testing for plan implementations. I create desktop procedures and collaborate with stakeholders to implement mitigations and workflow improvements.

Previously I led appeals and denials teams, drove a 90% denial turnover rate, coordinated special operations for new drug and managed-care implementations, and supported patients accessing assistance programs. I am a compassionate communicator, highly self-sufficient, and committed to resolving issues for patients and providers efficiently.

Experience

Work history, roles, and key accomplishments

Current

Clinical Operations Pharmacy Analyst

Current

AmeriHealth Caritas / PerformRX

Sep 2020 - Present (5 years 5 months)

Analyze prescription claim data to ensure correct adjudication per plan and CMS guidelines, identify and resolve discrepancies, and participate in audits and regression testing to maintain member impact-free corrections.

Regression Testing Excel CRM

Insurance Reimbursement Specialist

Diplomat Specialty Pharmacy / UnitedHealth Group

Mar 2020 - Sep 2020 (6 months)

Performed benefit investigations, initiated authorizations with payers and providers, communicated with patients, and supervised appeals/denials team achieving a 90% denial turnover rate.

Benefits Investigation Appeals Management Communicates With Patients Claims Processing Provider Liaison

Special Operations Coordinator

Diplomat Specialty Pharmacy

Jul 2008 - Mar 2020 (11 years 8 months)

Oversaw special operations workflows, led new drug and managed care implementations, documented process improvements, and supported providers and patients including access to assistance programs.

Process Improvement Implementation Managed Care Patient Advocacy Provider Relations Benefits Investigation Training

Lead Pharmacy Technician

Elkins Park Pharmacy

Jan 2000 - Jan 2008 (8 years)

Assisted pharmacists with prescription preparation, claims adjudication, inventory and state audit support, and managed patient interactions in a retail independent pharmacy.

Claim Adjudication Inventory Control Cash Handling

Pharmacy Technician

Huntingdon Valley Pharmacy

Jan 1999 - Jan 2000 (1 year)

Provided prescription filling support, inventory management, patient and provider communication, and assisted with state audits at an independent retail pharmacy.

Inventory Management Patient Provider Communication Claims Processing

Pharmacy Technician Supervisor

Diplomat Specialty Pharmacy

Supervised and trained pharmacy technicians, managed dispensing operations, inventory and drug shipments, and contributed to launching an online health data portal to track adherence and outcomes.

Team Supervision Pharmacy Operations Inventory Management Training Regulatory Compliance