Melissa Lomeli
Ontario,CA
Summary
Dynamic Adjudication Specialist with a proven track record at Polaris Pharmacy, excelling in problem-solving and analytical thinking. Adept at resolving payment discrepancies and ensuring accurate billing, I enhance customer relations through effective communication and documentation management. Committed to improving workflow and patient satisfaction in fast-paced environments.
Overview
8
8
years of professional experience
Work History
Adjudication Specialist
Polaris Pharmacy
01.2022 - Current
- Reviewed patient claims for accuracy, completeness, and obtained missing information.
- Called insurance companies to resolve payment discrepancies promptly.
- Followed up on unpaid claims within standard billing cycle timelines.
- Checked and corrected unbilled claim reports to ensure accurate billing.
- Admitted new patients and re-admitted returning patients by entering necessary information.
- Identified and billed secondary or tertiary insurances as required.
- Responded to inquiries from doctors, nurses, and insurance representatives regarding assigned accounts.
- Maintained comprehensive knowledge of insurance guidelines, including Medicare and Medi-Cal.
Pharmacy Technician
Premier Pharmacy Services
07.2019 - 07.2021
- Answered incoming phone calls, addressing inquiries from customers and healthcare providers.
- Stocked, labeled, and inventoried medications to maintain precise records.
- Assisted pharmacists with medication dispensing, labeling, and packaging to enhance pharmacy workflow.
- Calculated dosages, filled prescriptions, and prepared labels with utmost accuracy.
- Operated pharmacy computer systems to process prescription orders and monitor patient records.
Pharmacy Technician
Pharmedquest
01.2017 - 07.2019
- Entered new patient profiles and prescriptions into medication software system accurately.
- Verified patient data and billing information to ensure completeness and accuracy.
- Communicated with doctors' offices via telephone, fax, and email for efficient coordination.
- Recorded compounded products and prepared appropriate labels to meet regulatory standards.
Education
Pharmacy Technician License - Pharmacy
Baldwin Park Adult School
Baldwin Park, CA06-2012
High School Diploma -
Covina High School
Covina, CA06-2007
Skills
- Customer relations management
- Expert problem solving
- Analytical thinking
- Documentation management
- Team collaboration
Timeline
Adjudication Specialist
Polaris Pharmacy
01.2022 - Current
Pharmacy Technician
Premier Pharmacy Services
07.2019 - 07.2021
Pharmacy Technician
Pharmedquest
01.2017 - 07.2019
Pharmacy Technician License - Pharmacy
Baldwin Park Adult School
High School Diploma -
Covina High School
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