Anquenette Lewis
Brandon,MS
Summary
Experienced professional seeking a position to utilize expertise and maximize productivity within an organization that offers rewarding career opportunities. Demonstrated ability to collaborate effectively with teams through exceptional verbal and written communication skills.
Overview
15
15
years of professional experience
1
1
Certification
Work History
Claims Adjudicator
CareOne Pharmacy
Chicago, IL
11.2023 - Current
- Improved claim processing efficiency by streamlining workflows and implementing time-saving strategies.
- Consistently met or exceeded performance targets for claims processing and adjudication, contributing to overall departmental success.
- Built strong relationships with medical providers and legal representatives to facilitate information gathering for claims processing purposes.
- Optimized organizational efficiency by mentoring personnel on customer service protocols.
- Reached out to insurance carriers to obtain prior authorization for testing and procedures.
Prior Authorization Representative
Gainwell Technologies
Ridgeland, MS
09.2021 - Current
- Provided exceptional customer service, addressing inquiries from both patients and healthcare providers promptly and professionally.
- Ensured compliance with HIPAA regulations by maintaining strict confidentiality in handling sensitive patient information.
- Verified eligibility and compliance with authorization requirements for service providers.
- Processed new medication and refill requests for authorization.
- Improved patient satisfaction by efficiently processing prior authorization requests and ensuring timely responses.
- Streamlined workflow for faster approval turnaround times, handling high volume of insurance verification tasks.
- Reduced claim denials by thoroughly reviewing and analyzing medical necessity documentation before submitting for approval, ensuring all criteria were met.
Employment Specialist II
Professional Staffing Group
Jackson, MS
08.2020 - 06.2021
- Provide customer service and support for residents calling in regarding unemployment insurance
Health Insurance Claims Adjudicator
Partners Pharmacy
Stafford, TX
11.2018 - 05.2020
- Utilize remote desktop software along with end user to resolve issues using documented solutions.
- Reduced error rates in claims adjudication through meticulous attention to detail and thorough documentation review.
- Collaborated with interdisciplinary teams to develop best practices for resolving high-priority claims quickly and accurately.
- Supported growth in business revenue by maintaining an exceptional standard of accuracy in the adjudication process.
- Maintained knowledge of benefits claim processing, claims principles, medical terminology, and procedures and HIPAA regulations.
Payment Process Specialist
Sutherland Global
Houston, TX
09.2017 - 11.2018
- Provided input to policies, systems, methods, and procedures for the effective management and control of billing functions.
Retention Sales Consultant
Comcast
Jackson, MS
04.2014 - 07.2017
- Described use and operation of merchandise to customers.
Pharmacy Technician
Walgreens
Jackson, MS
03.2009 - 04.2014
- Submitted prior authorization to doctors' offices and insurance companies
Education
Bachelor of Science in Biology -
Texas Southern University
Skills
- Windows 8/10
- PowerPoint, Excel
- Framework
- Outlook
- Data Entry
- Cover My Meds
- Google Chrome, FireFox, Internet Explorer, Microsoft Edge
- Scanning, Faxing, Printing
- Electronic Data Interchange(EDI)
- Medical Billing
- Medical Documentation
- Point Click Care
- HIPAA/OSHA
- Good Communication and Presentation Skills
- Adept Multitasker
- Exceptional Problem Solver
- Creative Thinker and Close Attention to Details
- Excel, Word, 3M, EMR systems, Epic, Publisher
- Customer Service Skills
- ICD-10 (International Classification of Disease Systems)
- Inventory and Management
- Medication Preparation
- HIPPA Medicare/Medicaid
- Labelling and packaging medication
- Organized and Reliable
- Excellent Computer Skills
References
Available upon request
Certification
Pharmacy Technician Registration
Timeline
Claims Adjudicator
CareOne Pharmacy
11.2023 - Current
Prior Authorization Representative
Gainwell Technologies
09.2021 - Current
Employment Specialist II
Professional Staffing Group
08.2020 - 06.2021
Health Insurance Claims Adjudicator
Partners Pharmacy
11.2018 - 05.2020
Payment Process Specialist
Sutherland Global
09.2017 - 11.2018
Retention Sales Consultant
Comcast
04.2014 - 07.2017
Pharmacy Technician
Walgreens
03.2009 - 04.2014
Bachelor of Science in Biology -
Texas Southern University