THEA GREGORIO
Buena Park,CA
Summary
Resourceful Pharmacy Coordinator known for high productivity and efficient task completion. Possess specialized skills in Refill too soon management, regulatory compliance, and inventory control. Excel in communication, problem-solving, and teamwork, ensuring seamless pharmacy operations and patient care. Goal-oriented pharmacy assistant operates well in fast-paced, high-volume environments. Knowledgeable of state and federal guidelines for pharmacy operations and controls. Works well with patients, providers and pharmacy staff.
Overview
21
21
years of professional experience
Work History
Pharmacy Coordinator
SCAN Health Plan
Long Beach, CA
04.2022 - 10.2024
- Monitoring the pharmacy's inbox on a daily basis, including answering questions from different corporate departments. Request and collect relevant information by speaking with the members or pharmacies. Document appropriately and follow up as necessary.
- Performed data entry and processed tasks to update patient profiles with insurance information, refill requests and other changes. Daily, weekly, and monthly COB/PAP reports
- Processed prescriptions using pharmacy software Express Scripts and Evernorth Health Service Control Center, ensuring accuracy of drug names, dosages, and directions for use.
- Process Rx history report request by our internal Legal Department
- Kept accurate records of controlled substances received and dispensed in accordance with DEA regulations.
- Reported any discrepancies or errors in medication ordering or filling processes immediately to the pharmacist on duty.
Reconciliation Specialist
SCAN Health Plan
Long Beach, CA
09.2013 - 04.2022
- Researched and resolved all membership discrepancies for various prescription drug events
- Managed all reconciliation activities according to timeframe to ensure regulatory compliance with Medicare Managed Care, CMS
- Identify and investigate member data between various databases (MC400 and IKA systems) by reconciling, entering, correcting, tracking, and monitoring information
- Analyzed root causes and assisted in improving various reconciliation processes
Provider Database Specialist
United Healthcare Group
Santa Ana, CA
08.2007 - 08.2012
- Collection and maintenance of provider information
- Produced numerous reports related to provider network info, performs quality checks, and analyzes data
- Identify the areas for process improvement and process requests for data by adding and correcting entries into PBH/ UBH FACETS (Citrix) system
- Ensured data integrity and accuracy of provider information and regulatory compliance
- Processed and re-priced an excess of 100-200 healthcare claims per day for CNIC Health Solutions, a third-party administrator of health benefits, in areas of mental and behavioral health
Medical Case Installation
Pacificare Health System
Cypress, CA
09.2003 - 07.2005
- Gathered and verified information eligibility regarding PPO/HMO prospective enrollees
- Maintained accuracy of inventory of queue
- Coordinate internal and external resources to complete enrollment process in NICE/RIMS/PROD systems
- Input new and updated status changes on new open enrollments and other reinstating accounts
- Additionally provides members with courteous, friendly, fast and efficient service
- Provided guidance and support to staff members
Education
Health Sciences
Los Angeles Pacific College
Los Angeles, CA12-2024
Skills
- 21 years of experience in healthcare managed care setting
- Operational Oversight
- Collaboration and Teamwork
- Data Entry
- Pharmacy Policies and Procedures
- Regulatory reporting
- Prescription Verification
- Dispensing Medications
- Maintaining Patient Records
- Prescription Review and Dosage
- Medicare and Medicaid process
- Bilingual in English and Tagalog
References
Available upon request
Timeline
Pharmacy Coordinator
SCAN Health Plan
04.2022 - 10.2024
Reconciliation Specialist
SCAN Health Plan
09.2013 - 04.2022
Provider Database Specialist
United Healthcare Group
08.2007 - 08.2012
Medical Case Installation
Pacificare Health System
09.2003 - 07.2005
Health Sciences
Los Angeles Pacific College
Similar Profiles
Lane UtkovLane Utkov
Member Service Representative at SCAN Health PlanMember Service Representative at SCAN Health Plan
Dana JacksonDana Jackson
Concierge at SCAN Health PlanConcierge at SCAN Health Plan
AUDRIE GORDON, MSW, ASWAUDRIE GORDON, MSW, ASW
Care Manager/ Homeless Services at Independence At Home SCAN Health PlanCare Manager/ Homeless Services at Independence At Home SCAN Health Plan
Wenying BrownWenying Brown
Billing Concierge Advocate at SCAN Health PlanBilling Concierge Advocate at SCAN Health Plan
PAUL YOOPAUL YOO
General Manager at Mr. BBQGeneral Manager at Mr. BBQ