Summary
Overview
Work History
Education
Skills
Timeline
Generic

Keisha McKenzie

Kissimmee,FL

Summary

To seek and maintain full-time position that offers professional challenges utilizing interpersonal skills, excellent time management and problem-solving skills. Detail-oriented team player with strong organizational skills. Ability to handle multiple projects simultaneously with a high degree of accuracy.

Overview

17
17
years of professional experience

Work History

North Carolina Medicaid Enrollment Broker

TEKsystems
11.2023 - 06.2024
  • Enrolled current Medicaid recipients into NC Medicaid Managed Care Health Plan.
  • Educated Standard Plans members on the five Health Plans (Wellcare, United Healthcare Community Plan, Healthy Blue, AmeriHealth Caritas & Carolina Complete Health) available & the added services for members who qualify.
  • Educated Tailored Plan members on the four Health Plans (Alliance Health, Partners Health Management, Trillium Health, Resources & Vaya Health) available & the added services for members who qualify.
  • Instructed beneficiaries on how to complete their enrollment via paper form, mobile app and website.
  • Completed Health Plan (NC Medicaid Managed Care) transfer per member request.
  • Dis-enrolled Exempt members currently enrolled in Health Plan requesting to enroll into Medicaid Direct/Tailored Plan/Eastern Band of Cherokee Indians (EBCI) Tribal Plan.
  • Provided Choice Counseling for integrated Tailored Plans that provide physical health, pharmacy and enhanced behavioral health services for beneficiaries who have: mental health disorder/SUD/ I/DD/TBI.
  • Provided unprejudiced personalized enrollment counseling to NC Medicaid recipients.
  • Educated beneficiaries with accurate lucid knowledge of their enrollment options.
  • Assisted beneficiaries enrolling in NC Medicaid Managed Care Health Plan with their initial enrollment PCP selection.
  • Coordinate with local Department of Social Services, as needed.
  • Provided details regarding available Health Plans and Providers without displaying personal preference for one or the other.
  • Guided pre Medicare & Medicare beneficiaries with limited income and resources, in the right direction for assistance with covering medical cost.

Clinical Operations Technician

Prime Therapeutics LLC
04.2021 - 03.2023
  • Manage work queue and volumes to meet client specific turnaround times.
  • Perform outreach calls to pharmacies and physician’s offices related to the department process across multiple clients to obtain all necessary information related to UM requests, including occasional member assistance.
  • Research and respond to calls and emails.
  • Government Programs: Responsible to be proficient in dual reviews, compounds, etc. in addition to single review, approval/denial, etc.
  • Review criteria to determine if the request can be approved and accurately enter Prior Authorizations in claims system to ensure appropriate claims will adjudicate.
  • Navigated successfully between 8 different applications, multiple different systems- dual monitors, and toggling between screens simultaneously per day.
  • Systems utilized included; Cover my meds, RX Claims, BET Website (Benefits Editor Tool), Right Fax, WebEx, Microsoft Office (Excel, Word, PowerPoint, Outlook).

Customer Service Representative

Liveops (Self Employed)
10.2007 - 04.2021
  • Managed high-stress situations effectively, maintaining professionalism under pressure while resolving disputes or conflicts.
  • Resolved customer complaints with empathy, resulting in increased loyalty and repeat business.
  • Handled escalated calls efficiently, finding satisfactory resolutions for both customers and the company alike.
  • Responded to customer requests for products, services, and company information..
  • Ability to use multiple Client specific software and applications in order to service members, meeting client expectations on every call.
  • Accurate and efficient data entry abilities.
  • Provide an outstanding customer experience.
  • Able to handle billing, tech support, soft offers, hard sells, upsells, 3rd party offers, etc..

Education

High School Diploma -

Dekalb Technical College
Clarkston, GA
12.2000

Skills

  • Health insurance
  • Policy Feature Explanations
  • Written Communication
  • Policy Changes
  • Data Entry
  • Active Listening
  • HIPAA Compliance
  • Professional Demeanor
  • Customer service expertise

Timeline

North Carolina Medicaid Enrollment Broker

TEKsystems
11.2023 - 06.2024

Clinical Operations Technician

Prime Therapeutics LLC
04.2021 - 03.2023

Customer Service Representative

Liveops (Self Employed)
10.2007 - 04.2021

High School Diploma -

Dekalb Technical College

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Keisha McKenzie