Summary
Overview
Work History
Education
Skills
Languages
Timeline
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IVONNE MALDONADO

Vineland,USA

Summary

Senior Representative specializing in insurance claim processing and customer service at Accredo Specialty Pharmacy. Proven track record in resolving complex eligibility inquiries and enhancing patient medication access. Bilingual communicator skilled in team collaboration and pharmacy software, ensuring compliance and operational efficiency. Expertise in Medicaid and Medicare regulations, with a focus on streamlining operations and improving process efficiency.

Overview

22
22
years of professional experience

Work History

Eligibility Senior Representative

Accredo Specialty Pharmacy
, NJ
01.2023 - Current
  • Reviewed insurance documentation for compliance with pharmacy and medical policies.
  • Maintained accurate records in pharmacy management systems for eligibility verification.
  • Assisted team members in resolving complex eligibility inquiries and issues.
  • Monitored insurance policy changes impacting patient medication access.
  • Collaborated with diverse coworkers to achieve goals and address product-related issues.
  • Scheduled shipments and ensured timely clearance.
  • Executed daily tasks with accuracy and efficiency.
  • Prioritized and organized responsibilities to meet service objectives.

Pharmacy Tech Lead

Express Scripts
Florence, NJ
12.2019 - 01.2023
  • Collaborated with peers, technicians, and pharmacists to prioritize and fulfill orders efficiently.
  • Utilized pharmacy software systems to track prescriptions and patient records.
  • Inspected medication storage areas to monitor expiration dates and maintain adequate inventory levels.
  • Executed various pharmacy operations with a focus on accuracy, efficiency, and service quality.
  • Managed inventories by rotating stock, removing expired products, and resolving discrepancies in drug counts.
  • Checked expiration dates on medications to ensure that only unexpired products were dispensed.

Patient Care Coordinator

ASPN Pharmacies
Feasterville, PA
07.2018 - 12.2019
  • Created new customer profiles and updated changes such as demographics, allergies, and new medications in pharmacy computer systems.
  • Teamed with peers, technicians and pharmacists to prioritize and complete orders.
  • Assisted pharmacist with clearing high volume of prescriptions and responded to customer questions.
  • Transmitted claims to insurance companies for payment and reconciled EOBs.
  • Flagged potential drug interactions and allergies to prescribed medications for patients with different health conditions.
  • Maintained strict patient confidentiality to adhere to HIPAA regulations and avoid data compromises.
  • Completed and filed patient paperwork, updating records in system with insurance carrier changes and allergy information.
  • Communicated with patients to ensure quality of care and develop care plans.

Eligibility Pharmacy Technician

Express Scripts
Feasterville, PA
09.2003 - 05.2017
  • Teamed with peers, technicians and pharmacists to prioritize and complete orders.
  • Created new customer profiles and updated changes such as demographics, allergies and new medications in pharmacy computer systems.
  • Assisted pharmacist with clearing high volume of prescriptions and responded to customer questions.
  • Transmitted claims to insurance companies for payment and reconciled EOBs.
  • Flagged potential drug interactions and allergies to prescribed medications for patients with different health conditions.
  • Performed wide range of pharmacy operations with strong commitment to accuracy, efficiency and service quality.
  • Completed and filed patient paperwork, updating records in system with insurance carrier changes and allergy information.
  • Worked with insurance companies to process claims, resolve problems and obtain payments.
  • Established and updated patient profiles, including lists of medications and insurance details.
  • Consulted with customers via telephone or in-person to assist with navigating pharmacy systems and completing requests.
  • Compiled customer demographic, allergy and medical history background.
  • Requested scripts from doctors and verified insurance and coding.

Education

High School Diploma -

Luis Munoz Marin High School
Yauco, PR
06.1993

Industrial Engineering -

Polytechnic University Of PR
San Juan, PR

Skills

  • Data entry and management
  • Customer service excellence
  • Call answering and routing
  • Patient profile management
  • HIPAA compliance expertise
  • Insurance claim processing
  • Staff leadership and development
  • Microsoft Office proficiency
  • Bilingual communication
  • Insurance verification processes
  • Pharmacy software utilization
  • Effective communication skills
  • Team collaboration

Languages

Spanish, Native/ Bilingual

Timeline

Eligibility Senior Representative

Accredo Specialty Pharmacy
01.2023 - Current

Pharmacy Tech Lead

Express Scripts
12.2019 - 01.2023

Patient Care Coordinator

ASPN Pharmacies
07.2018 - 12.2019

Eligibility Pharmacy Technician

Express Scripts
09.2003 - 05.2017

High School Diploma -

Luis Munoz Marin High School

Industrial Engineering -

Polytechnic University Of PR

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