Lakeena Johnson
Atlanta,GA
Summary
Dedicated administrative professional well-versed in communication and team building. Knowledgeable in medical terminology and scheduling. Ready to bring 5 years of relevant work experience to your team. Versatile professional serves as first point of contact for patients by verifying insurance, handling paperwork and preparing records. Patient-oriented and helpful candidate familiar with MS Office and EHR systems coupled with thorough knowledge of medical terminology. Committed to providing personalized service and quality patient care.
Overview
12
12
years of professional experience
Work History
Insurance Specialist 2
Kelly Services
05.2024 - Current
- Provide subject matter expertise on medical and prescription insurance coverage/ verification, claim billing, medication prior authorization and appeal filing, and alternate financial assistance opportunities. Accurately documents information in the appropriate systems and formats. Communicate the status of the referral to the physician and the patient via phone, fax, and/or the core pharmacy system as per established policies and procedures.
- Assist offices through the entire documentation and filing process for prior authorizations and appeals. Monitor the status to ensure a rapid turnaround resulting in procurement of the drug product for the patient.
- Use internal and web tools and communicate and collaborate with health insurance payors and providers to investigate pharmacy and medical benefits. Obtain and confirm information to maintain Pharmacy Solutions’ payor intelligence resources.
- Meet or exceed department standards relative to performance metrics. Take responsibility and accountability for the day-to-day execution of tasks and is responsible for providing periodic progress reports on goals and metrics. Work cross-functionally to identify and share opportunities for process and productivity improvement and to troubleshoot and/or resolve situations, taking ownership as needed.
- Decide whether to reinvestigate or accept obtained benefit verification based on reasonableness and accuracy. Determine whether to escalate issues/concerns to management for review, guidance, and resolution. Participate in quality monitoring and in identifying and reporting quality issues.
- Enter patient demographic and health insurance information into the hub information system and notify the physician of any incomplete or incorrect insurance information
- Understand and comply with all required training, including adherence to federal, state, and local pharmacy laws, HIPAA policies and guidelines, and the policies and procedures of Pharmacy Solutions and AbbVie.
- Identifies potential Adverse Event situations for reporting to Pharmacovigilance ensuring AbbVie meets FDA regulations.
Completes all required training and performs all functions in the position e.g., Soft Skills certification, product and disease overviews. Perform additional tasks, activities, and projects as deemed necessary by management.
Insurance Verification Specialist
Family Practice Center P.C
05.2022 - 10.2023
- Assured timely verification of insurance benefits prior to patient procedures or appointments.
- Made contact with insurance carriers to discuss policies and individual patient benefits.
- Maintained strong knowledge of basic medical terminology to better understand services and procedures.
- Communicated verification and authorization status updates with billing department to facilitate decision-making for patient admissions and insurance coverage.
- Observed strict procedures to protect sensitive patient information, medical records and payment data.
- Verified client information by analyzing existing evidence on file.
- Resubmitted claims after editing or denial to achieve financial targets and reduce outstanding debt.
- Posted payments to accounts and maintained records.
- Answered constant flow of customer calls with minimal wait times.
- Investigated and resolved customer inquiries and complaints quickly.
- Exhibited high energy and professionalism when dealing with clients and staff
Insurance Verification/ Credentialing Specialist
Valley Health Partners Children’s Clinic
04.2020 - 05.2022
- Reduced wait times by optimizing appointment scheduling and improving clinic flow
- Communicated verification and authorization status updates with billing department to facilitate decision-making for patient admissions and insurance coverage.
- Worked closely with social workers identifying at-risk families offering guidance on parenting techniques ultimately enhancing family dynamics.
- Delivers the high standard of customer service necessary to maintain the overall patient experience.
- Assisted patients in filling out check-in and payment paperwork.
- Took copayments and compiled daily financial records.
- Posted payments to accounts and maintained records.
- Balanced deposits and credit card payments each day.
- Used Epic to schedule appointments.
- Registered and verified patient records before triage with most up-to-date information
- Reviewed and corrected claim errors to facilitate smooth processing
- Facilitated communication between patients and various departments and staff.
- Followed document protocols to safeguard confidentiality of patient records.
- Assured timely verification of insurance benefits prior to patient procedures or appointments.
- Made contact with insurance carriers to discuss policies and individual patient benefits.
- Maintained strong knowledge of basic medical terminology to better understand services and procedures.
Claims Customer Service Representative
PMA Companies
03.2017 - 05.2020
- Processed and recorded new policies and claims.
- Provide accurate and timely resolution to claims customer service inquires
- Advise clients by telephone of claim status
- Worked closely with medical providers and claim adjusters
- Coordinate clients follow up calls and appointments
- Provide support and back up assistance to other areas of CSC.
- Documented customer contact to maintain record of customer interactions and elevate quality of service
- Carried out administrative tasks by communicating with clients, distributing mail and scanning documents.
- Verified client information by analyzing existing evidence on file
- Conducted detailed client intakes and entered information into company database.
Healthcare Customer Service Representative
Aetna Health Insurance
04.2012 - 03.2017
- Investigated and resolved customer inquiries and complaints quickly.
- Educated customers about billing, payment processing and support policies and procedures.
- Promoted superior experience by addressing customer concerns, demonstrating empathy and resolving problems swiftly.
- Trained new personnel regarding company operations, policies and services.
- Cross-trained and provided back up for customer service managers.
- Assisted clients in understanding complex insurance terms and conditions, leading to better decision-making and policy selection.
- Verified insurance coverage by telephone and online to guarantee proper reimbursement of benefits and estimate patients' financial responsibilities.
- Monitored changes in health insurance laws and regulations to verify continuous compliance.
- Assisted clients with filing and tracking health insurance claims to facilitate swift settlements.
- Reduced error rates in claims adjudication through meticulous attention to detail and thorough documentation review.
- Improved customer satisfaction levels by providing clear communication and prompt resolution of claim inquiries.
- Managed a high volume of claims daily, consistently meeting deadlines and maintaining a low error rate.
- Evaluated medical claims for accuracy and completeness and researched missing data.
Education
High School Diploma -
Pennsylvania School of Business
06.2008
Skills
- Patient Health Information Access
- Provider Credentialing
- Prior authorization processing
- Medical Billing
- Claim Review
- Payment Scheduling and Collection
- Schedule Patients
- Electronic Medical Records
- Medicaid/Medicare Knowledge
- ICD10
- CPT Codes
- Insurance Coverage Verification
- Eligibility Determination
- Customer Service
- HIPAA Compliance
- Claims Processing
- Insurance Billing
- Patient Health Information Access
- Data Entry Software
- EOBs
- Insurance Authorizations
- Payment Scheduling and Collection
- Appeals
Timeline
Insurance Specialist 2
Kelly Services
05.2024 - Current
Insurance Verification Specialist
Family Practice Center P.C
05.2022 - 10.2023
Insurance Verification/ Credentialing Specialist
Valley Health Partners Children’s Clinic
04.2020 - 05.2022
Claims Customer Service Representative
PMA Companies
03.2017 - 05.2020
Healthcare Customer Service Representative
Aetna Health Insurance
04.2012 - 03.2017
High School Diploma -
Pennsylvania School of Business