Open To Work
Melissa Lomeli
Ontario
Work Preference
Summary
Dynamic Adjudication Specialist with extensive experience at Polaris Pharmacy, excelling in claim review and payment resolution. Proven expertise in insurance guidelines and analytical thinking, ensuring billing accuracy and enhancing customer relations. Adept at managing patient data entry and fostering team collaboration to optimize workflow and achieve timely processing of claims.
Overview
9
9
years of professional experience
1
1
Certification
Work History
Adjudication Specialist
Polaris Pharmacy
Covina
01.2022 - Current
- Reviewed patient claims for accuracy and completeness while obtaining missing information.
- Resolved payment discrepancies by promptly contacting insurance companies.
- Followed up on unpaid claims within standard billing cycles to ensure timely processing.
- Checked unbilled claim reports, correcting errors to maintain accurate billing practices.
- Admitted new patients and re-admitted returning patients by entering necessary data.
- Identified and billed secondary or tertiary insurances as required for comprehensive coverage.
- Responded to inquiries from medical staff and insurance representatives regarding accounts.
- Maintained extensive knowledge of insurance guidelines, including Medicare and Medi-Cal.
Pharmacy Technician
Premier Pharmacy Services
Baldwin Park
07.2019 - 07.2021
- Answered incoming calls, resolving inquiries from customers and healthcare providers.
- Maintained precise records by stocking, labeling, and inventorying medications.
- Supported pharmacists in dispensing, labeling, and packaging medications to optimize workflow.
- Calculated dosages and filled prescriptions with accurate label preparation.
- Operated pharmacy computer systems to process prescription orders and track patient records.
Pharmacy Technician
Pharmedquest
Brea
01.2017 - 07.2019
- Accurately entered patient profiles and prescriptions into medication software system.
- Verified patient data and billing information for completeness and accuracy.
- Coordinated efficiently with doctors' offices through telephone, fax, and email.
- Recorded compounded products and prepared labels to comply with 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
- Long-term care
- Claim review and payment resolution
- Insurance guidelines and billing accuracy
- Patient data entry and prescription processing
- Proficient in QS1 and Framework
Certification
Pharmacy Technician License
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