Melanie Lee
Plantation,FL
Summary
Dedicated and certified Pharmacy Technician with extensive experience in retail, long-term care, hospital settings, infusion therapy, and insurance. Proven ability to multitask effectively while managing and developing efficient workflows to meet operational goals. Eager to leverage diverse expertise to enhance organizational growth and success through exceptional service and a commitment to patient care. Passionate about contributing to a collaborative team environment that prioritizes excellence in pharmacy operations.
Overview
23
23
years of professional experience
1
1
Certification
Work History
Prior Authorization Specialist
Centene Pharmacy Services
01.2025 - Current
- Reviewed prior authorization requests efficiently, ensuring compliance with company policies and regulatory standards.
- Evaluated clinical criteria for approval or denial of services requiring pre-authorization.
- Collaborated with healthcare providers to obtain additional information, enhancing accuracy of authorization determinations.
- Verified eligibility and compliance with authorization requirements for service providers.
- Enhanced efficiency in processing prior authorization requests by streamlining documentation procedures.
Pharmacy Reimbursement Specialist
Broward Medical Systems
11.2022 - 12.2024
- Manage and identify a portfolio of pharmacy claims including specialty medications, dme and otc
- Resolve billing issues including denied claims requiring prior authorization
- Daily follow up and completing assigned tasks
- Assist patients with pap (patient assistant programs), foundations, and copay assist
- Keep track of patient medication refills and profile to ensure high level patient care
- Coordinate medication deliveries via courier and/or physician's office
- Answered incoming phone calls and addressed questions from customers and healthcare providers.
Order Entry Technician III
Omnicare LTC
09.2018 - 11.2022
- Verify patient demographics and enter orders received from LTC facilities
- Multitask within inbound and outbound calls and internal transfers
- Process stat orders and deliveries
- Assist with filling and staging medication properly
- Responsible for making sure all queues have been completed before shift ends
- Contributed to departmental goals by consistently meeting or exceeding daily performance metrics for order entry speed and accuracy.
Account Claims Resolution Specialist
Conifer Health Solutions
09.2015 - 09.2018
- Manage and review account balances for discrepancies
- Research, analyze and appropriately resolve ejected claims
- Hospital billing and A/R follow up
- Making outbound calls when necessary
- Complete special assignments and other tasks assigned
Senior Pharmacy Technician
Locatel Health
07.2014 - 09.2015
- Submitting prior authorizations for patient medication
- Assist patients with medical care
- Prepare prescription orders for pharmacist review and verification
- Multitask and prioritize workflow to ensure efficiency
Order Entry Pharmacy Technician III
Aetna RX Home Delivery
12.2008 - 11.2013
- Served as a Subject Matter Expert (SME) for escalated and complex issues
- Responsible for training and mentoring new hires and team members on protocol and processes
- Prescription processing by entering patient information and medication orders
- Innovate strategies to streamline processes
- Responsible for assigning daily tasks for workflow optimization
Pharmacy Inventory Specialist
Walgreens
03.2006 - 12.2008
- Reviewing pharmacy inventory reports on a daily basis
- Inventory management responsible for keeping track of cycle counts
- Pulling expired processing returns
- Performing checks and balances to assure medication availability
- Conduct regular inventory counts, and place orders for stock replenishment
Data Entry Technician
Guardian Pharmacy
06.2005 - 03.2006
- Entering patient demographics and prescription orders
- Making sure orders processed in a timely manner
- Assisting facility staff with medication order request/status
- Packaging medication appropriately for delivery
- Reviewing claims for billing accuracy
Pharmacy Technician
CVS Pharmacy
10.2003 - 06.2005
- Reviewed prior authorization requests efficiently, ensuring compliance with company policies and regulatory standards.
- Evaluated clinical criteria for approval or denial of services requiring pre-authorization.
- Collaborated with healthcare providers to obtain additional information, enhancing accuracy of authorization determinations.
- Verified eligibility and compliance with authorization requirements for service providers.
- Enhanced efficiency in processing prior authorization requests by streamlining documentation procedures.
Education
Broward College
Fort Lauderdale, FL06-2028
Skills
- Decision-making, Conflict resolution, and Adaptability
- Detail-oriented in maintaining, updating, and enforcing SOPs
- Effective communication skills
- Proficiency in building and cultivating teams
- Workflow optimization and management
- Competency evaluating strengths & weaknesses
- Able to communicate with patients, providers, clinicians, and team members
- URAC Pharmacy protocol and compliance guidelines
- Strong data entry skills with focus on accuracy
- Proficient in various pharmacy processing systems
Certification
- FL Dept of Health Pharmacy Technician Registration
- PTCB National Pharmacy Technician Certification
Timeline
Prior Authorization Specialist
Centene Pharmacy Services
01.2025 - Current
Pharmacy Reimbursement Specialist
Broward Medical Systems
11.2022 - 12.2024
Order Entry Technician III
Omnicare LTC
09.2018 - 11.2022
Account Claims Resolution Specialist
Conifer Health Solutions
09.2015 - 09.2018
Senior Pharmacy Technician
Locatel Health
07.2014 - 09.2015
Order Entry Pharmacy Technician III
Aetna RX Home Delivery
12.2008 - 11.2013
Pharmacy Inventory Specialist
Walgreens
03.2006 - 12.2008
Data Entry Technician
Guardian Pharmacy
06.2005 - 03.2006
Pharmacy Technician
CVS Pharmacy
10.2003 - 06.2005
Broward College