Jamie Hashimoto

Experience

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  Walgreens Pharmacy

  Mar 2000 - Apr 2001

  Pharmacy Technician

  Processed and filled prescriptions submitted via fax and paper prescriptions brought in by patients. Verified patient demographics and insurance information via online computer system. Assisted with inventory and reordering as needed. Covered the pharmacy counter and register under the supervision of the pharmacist.

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  Swissport

  Apr 2001 - Jul 2002

  Passenger Service Agent

  Assisted passengers traveling between Russia and the United States.Assisted arriving passengers through US Customs.Checked-in passengers departing from the US to Russia in accordance with Transportation Security Administration (TSA) and the Federal Aviation Administration (FAA) regulations.

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  Afterhours Formal Wear

  Aug 2002 - Aug 2005

  Store Manager

  Interviewed, hired, trained and maintained staff of four to seven peoples. Performed daily bookkeeping, month-end reporting, and payroll.Implemented required operational procedures and maintained procedures on a day-to-day basis.Assisted clients in choosing formalwear for their special events.Met monthly financial goals, while reducing administrative costs.AchievementsStore Manager of the Month - March and August 2005

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  CHARTWELL UC DAVIS HEALTH SYSTEM - Home Infusion Pharmacy

  Aug 2005 - May 2010

  Authorization Supervisor

  Performed administrative and authorization functions at the branch office, providing leadership for the authorization team. Provided staff development; utilized appropriate management skills to motivate, discipline, and evaluate staff. Processed and reviewed multiple reports weekly and monthly to ensure all patient deliveries were processed in compliance within each Insurance guidelines, tracked our active patient census and our monthly discharged patients.Maintained updated knowledge of industry, regulatory, insurance and authorization standards. Trained all new Authorization and Intake staff and continued ongoing training programs for the departments to ensure compliance with all industry and regulatory standards.Assisted the Billing Department to obtain proper reimbursement for all services rendered. Processed prescription drug and enteral formula claims. First contact to resolve patient, physician, and hospital complaints.Worked closely with the General Manager and Intake/Authorization Manager on multiple projects to reduce costs and increase efficencies for maximum profitability. Monthly prior authorization audits for accuracy of HCPCS and ICD 9 coding.Processed monthly Medi-cal, Medi-care and Commercial insurance eligibility. AchievementsNovember 2009 completed a profitability analysis of our existing ventilator patients and determined changes that will save Chartwell approximately $32,000.00 annually. Built a rapport with Health Net Insurance, which directly allowed Chartwell to obtain a new insurance contract allowing us to expand our patient base.August 2009, directly responsible for bringing the unbilled hold ticket amount down by 96%, allowing Chartwell to collect more than $34,000 in unpaid claims.Participated in recruiting, interviewing, and training 5 new Authorization Specialist. Departmental order/fill accuracy rate at or above 98%. January 2010 Employee of the Month. Show less

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  Health Net of California Inc

  Jun 2010 - May 2012

  Utilization Management Supervisor - State Health Progams

  Provided staff development; utilized appropriate management skills to motivate, discipline, and evaluate staff. Created a positive climate for the department which stimulates a positive work environment and maximize productivity. Organized and prioritized daily workload to ensure completion within assigned timelines. Managed multiple department projects, while working collaboratively with internal and external customers. Recommended and implemented changes in department process to improve efficiency and cost effectiveness.Created department desktop policies and procedures to ensure alignment with the Medi-Cal Provider Manual. Collaborated with other departments within the State Health Programs to reduce redundancy of internal processes and increase efficiency. Created and implemented a new audit process to review the accurate processing of departmental work including; out-patient referrals, in-patient hospital admissions, CCS referrals and inbound provider phone calls.Assisted contracted providers and facilities to research referral, prior authorization and claims issues, collected required information and/or communicate requirements or approval determinations.Identified and referred members who meet criteria for disease management or complex case management.Provided administrative support to the management team by anticipating their needs. AchievementsRevamped the internal durable medical equipment and home infusion prior authorization process for Health Net, State Health Programs. Resulted in greater efficiencies and reduced duplication of efforts among multiple departments.Worked in partnership with the Health Net State Health Programs Claims Department to reveal deficiencies in the claims payment process that produced an initial monthly savings of $10,000 in overpaid claims.October 2010 and June 2011 SPOT award winner, Health Net.Maintain a 96% prior authorization referral processing accuracy rate at Health Net. Show less

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  Sutter Care at Home

  May 2012 - Jun 2014

  Regional Office Manager - Home Health Division

  Provided direct oversight and management of 23 office support staff. Responsible for planning, directing and controlling branch office support functions. Coordinated all systems and procedures to assure the most efficient functioning of the assigned departments and their interrelation to total branch operations. Ensured proficiency in each department and provided coverage as needed. Worked in conjunction with the Branch Administrator and Director of Patient Care Services by addressing HR issues and concerns, including hiring, disciplinary actions, terminations and other functions and projects assigned by the Branch Administrator.Created and implemented efficient processes and procedures for all front office position, including elimination of duplicate efforts among team members.Developed new hire training kits to provide support and education to new staff. Analysis of deficient productivity of clinical staff, identify barriers and provide recommendations for improvement. Collaborated with other divisions of SCAH regarding additional services and/or transition of care for patients. AchievementsIncrease in average daily home health visits from 3.8 per 8 hours to 4.2 per 8 hours increasing our revenue and decreasing our average cost per visit by 6%.Increased patient satisfaction (Press Ganey) from 17th percentile to 55th percentile over one years time. Enhanced daily efficiencies in the Intake department by developing a paperless workflow system. Successfully regionalized the front office staff for multiple Home Health branches. Show less

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  Sutter Health Plus

  Jun 2014 - now

  Pharmacy Benefits Manager (PBM) performance oversight and monitoring. Including oversight of pharmacy and medication related issues for members. Ensure that the PBM is following proper practices and procedures related to benefits, compliance, and operational policies and procedures.Conduct annual PBM onsite audits to review specialty product channeling, compliance with the Department of Managed Health Care (DMHC) regulations, cost analysis - contract rates, rebates, and fees. Monitor, analyze and if possible, manage high cost pharmacy claims.Responsible for the coordination of services and cost effective management of pharmaceutical resources to meet individual members' health care needs and promote positive health care outcomes.Prepare summary reports and assessments for the Sutter Health Plus P&T Committee, Quality Improvement Committee, and Employer Groups.Review pharmacy benefit information in member facing documents.Consult with issues involving member appeals and grievances. Show less PBM evaluation, implementation, and oversight. Support PBM analytics, annual cost analysis, possible rate negotiations, and audit.Conduct onsite evaluations of our PBM, specialty and mail-order pharmacy.Research pharmacy-economic, pharmacy benefit design, and pharmacy clinical trends as they relate to the Pharmacy Benefit Program.Clinical monitoring, oversight and identify areas for new or increased performance standards and satisfaction guarantees.Monitor, analyze and if possible manage high cost pharmacy claims.Provides timely, accurate responses and resolutions to member complaints, and support for appeals and grievances.Prepare summary reports, research and technology assessments for QI Committee and Pharmacy & Therapeutics Committee.Supports cross-functional initiatives that are intended to drive quality performance improvement, customer satisfaction, and improve compliance.AchievementsIdentified medication claims saving opportunities that resulted in an annual savings of over $100,000.Developed and implemented custom key program indicator (KPI) dashboard.Managed increased appeals volume of 62% with no additional staffing through LEAN measures.Successful mail-order campaign that resulted in $828,418 in annual savings. Show less Analyze appeals and grievance data to evaluate the efficiency and effectiveness of processes and procedures for health plan members. Serves as a project leader for cross-functional initiatives that are intended to drive quality performance improvement and member satisfaction.Perform quality audits member services; assist in developing and implementing preventive and/or corrective action plans as needed.Monitors quality indicators and reports; including potential quality issues, peer review cases and all appeals and grievance related activities.Supports established committees by organizing and publishing detailed agendas, documenting minutes, maintain work plans, performing follow up and preparing and publishing reports.Tracks quality improvement activities, assesses trends and provides reporting to various departments and committees.Ensures minutes of key committees are prepared in a manner to comply with DMHC and NCQA standards. Work with Sutter Health affiliates and plan partners in regards to member appeals and grievances. Help to educate Sutter Health affiliates and plan partners on DMHC guidelines, SHP policy and procedures, and to better assist SHP members navigate their insurance plan.AchievementsDeveloped new Appeals and Grievance workflow and documentation system to reduce redundancy and processing turn-around-times by 8%.Successful Department of Managed Health Care (DMHC) audit of the Care Management Department Show less

  • Pharmacy Analyst Lead, CPhT

    Feb 2020 - now

  • Pharmacy Analyst, CPhT

    May 2015 - Feb 2020

  • Clinical Quality and Program Change Specialist

    Jun 2014 - May 2015