Laconda Johnson
Orlando,Florida
Summary
Over 8 years of customer service experience in healthcare field. Insurance verification, referrals, and prior authorization experience. Take calls from providers regarding authorization status. Experience with Medicare/Medicaid. Call Center Experience, Provider and Member service experience. Good communication and writing skills. Proficient in Microsoft Office Suite (Word, Excel and Outlook) Process Observations for approval. Inform Providers of updated authorizations status. Provide information on durable home medical or home health agency provider services. Trainer, Create Authorizations, Send out approval letters, Assist with Multiple Lines of Business.
Overview
10
10
years of professional experience
Work History
Authorization Specialist III
01.2024 - Current
- Create new authorizations for processing
- Assist co-workers in group chat for assistance
- Upload clinical documentation to attach to authorization
- Process Inpatient Medical authorizations
- Approve Obstetrics authorization also send approval letter for approval
- Send RFI for clinicals request for provider/ facility
- Process Inpatient/Outpatient behavioral authorization request.
Behavioral Referral Specialist II
Sunshine Health
02.2020 - 01.2024
- Assist with training new employees
- Create new authorizations for processing
- Assist co-workers in group chat for assistance
- Assist supervisor in meetings to provide plan for better process for co-workers to meet productivity
- Upload clinical documentation to attach to authorization
- Process Inpatient Medical authorizations
- Approve Obstetrics authorization also send approval letter for approval
- Send RFI for clinicals request for provider/ facility.
Behavioral Referral Specialist
Sunshine Health
Maitland, FL
04.2018 - 02.2020
- Assist with training new employees
- Create new authorizations for processing
- Take inbound calls from providers for new inpatients
- Send out Approval letters to providers
- Provide Information to providers regarding authorization status
- Assist Durable Medical and home health department with inbound calls
- Assist Ambetter Medical Department with creating new authorizations.
Referral Specialist
HealthCare Support
Maitland, FL
10.2017 - 04.2018
- Process Observations for approval
- Take inbound calls from providers for home health authorization status
- Liaison between internal calls to update members on authorization status
- Approve Dental Appointment for providers
- Update providers on DME status of authorization
- Train new employees.
Customer Service Rep
K force
Orlando, FL
11.2016 - 03.2017
- Take inbound from Pharmacies to process refill to soon overrides
- Receive calls from members regarding prescriptions rejections
- Take calls to authorizations for updated status.
Member Services
Prime Therapeutics
10.2014 - 11.2016
- Answer 50+inbound calls to process refills of medication
- Initiated and process prior authorizations and maintained authorization list
- Took calls from providers in regard to authorizations
- Insurance Verification and member eligibility
- Create demographics for new patients and adding new Insurance Information
- Explain copays to members prior to processing orders
- Train new employees.
Education
High School Diploma -
Jones High School
06.1988
Skills
- Customer service
- Insurance verification
- Referrals
- Prior authorization
- Medicare/Medicaid
- Call center experience
- Provider and member service
- Communication skills
- Writing skills
- Proficient in Microsoft Office Suite (Word, Excel, Outlook)
- Process observations for approval
- Inform providers of updated authorization status
- Provide information on durable home medical or home health agency provider services
- Trainer
- Create authorizations
- Send out approval letters
- Assist with multiple lines of business
- Upload clinical documentation to attach to authorization
- Process inpatient medical authorizations
- Approve obstetrics authorization and send approval letters
- Send RFI for clinicals request for provider/facility
- Process inpatient/outpatient behavioral authorization request
Timeline
Authorization Specialist III
01.2024 - Current
Behavioral Referral Specialist II
Sunshine Health
02.2020 - 01.2024
Behavioral Referral Specialist
Sunshine Health
04.2018 - 02.2020
Referral Specialist
HealthCare Support
10.2017 - 04.2018
Customer Service Rep
K force
11.2016 - 03.2017
Member Services
Prime Therapeutics
10.2014 - 11.2016
High School Diploma -
Jones High School