Lakeena Johnson
Orlando
Summary
Efficient and detail-oriented professional with 5 years of experience in medical claims and customer support. Expertise in ENR and billing systems, ensuring accuracy and compliance under strict guidelines. Strong communication skills with remote support experience and a focus on improving operational efficiency.
Seasoned insurance specialist with excellent planning and problem solving abilities. Offering several years of experience and a willingness to take on any challenge. Organized, driven and adaptable professional with successful history managing high caseloads in fast-paced environments.
Overview
13
13
years of professional experience
1
1
Certification
Work History
Insurance Specialist II
Kelly Services
Atlanta
05.2024 - Current
- Provided subject matter expertise in medical and prescription insurance coverage and verification.
- Handled claim billing, medication prior authorizations, appeals, and alternate financing.
- Submitted documentation for prior authorizations and appeals to ensure compliance with payer guidelines.
- Monitored turnaround times, recurring claims, and reporting for FBA compliance.
- Collaborated with insurance payers, providers, and internal pharmacy solutions teams.
- Reviewed documentation for accuracy and completeness in claims submissions.
- Processed insurance claims for various policies and coverage types.
- Managed communication between clients and insurance providers effectively.
- Coordinated with clients to explain policy details and claim procedures.
- Analyzed client needs to recommend suitable insurance options.
- Provided guidance to customers regarding available insurance plans and their benefits and limitations.
- Participated in training programs designed to enhance knowledge base in areas such as underwriting, sales, product development.
- Managed denials, late payments, extensions and other special circumstances by following up with relevant parties.
Insurance/Medical Billing Specialist
Family Practice Center PC
Atlanta
06.2022 - 10.2023
- Verified insurance benefits, eligibility, and documented communications accurately.
- Contacted insurance carriers to confirm policies.
- Maintained patient data, updated billing systems, and ensured financial and regulatory compliance.
- Resubmitted claims, managed account records, and resolved complaints efficiently.
- Communicated with insurance providers to resolve verification discrepancies.
- Maintained up-to-date knowledge of insurance regulations and policy changes.
- Verified that patients had proper insurance coverage prior to procedures or appointment scheduling.
- Developed a working knowledge of insurance plans, including Medicare and Medicaid regulations and requirements.
- Retained strong medical terminology understanding in effort to better comprehend procedures.
- Processed billing statements using advanced accounting software.
- Communicated with clients regarding billing inquiries and discrepancies.
Front Desk Receptionist
Dental Dreams LLC
Allentown
03.2020 - 06.2022
- Greeted patients warmly upon arrival at the dental office.
- Managed appointment scheduling for optimal patient flow and service efficiency.
- Answered phone calls and addressed inquiries regarding dental services.
- Utilized dental software for managing patient accounts and billing tasks.
- Scheduled cleanings and dental appointments for patients using appointment software.
- Verified patient's eligibility for benefits under various insurance plans.
- Answered incoming calls, scheduled appointments, and confirmed patient visits.
- Managed front desk operations including scheduling appointments, collecting payments.
- Verified, updated and entered patient information into system.
- Ensured that all HIPAA regulations were followed while handling confidential patient information.
- Educated patients on proper oral health care instructions and preventive measures.
- Ordered and maintained supply inventory for medical office.
Claims Customer Service Representative
PMA Companies
Allentown
04.2016 - 05.2020
- Verified insurance coverage and monitored regulatory updates.
- Helped clients file and track claims accurately.
- Processed claims inquiries using company systems and protocols.
- Processed payments for approved claims within established time frames.
- Assisted customers with the completion of forms related to their insurance policies or claims process.
- Performed administrative duties such as filing documents related to customer interactions or updating databases with pertinent information.
- Investigated discrepancies between customer's records and company documents to resolve disputes quickly
Healthcare Customer Service Representative
Aetna Health Insurance
Allentown
04.2012 - 03.2016
- Educated customers on billing policies and coverage.
- Trained new hires on internal systems and best practices.
- Verified insurance coverage and assisted with claim documentation.
- Assisted members with inquiries regarding health insurance coverage and benefits.
- Documented interactions in Aetna's customer relationship management system.
- Resolved customer issues through effective communication and problem-solving techniques.
- Coordinated with healthcare providers to ensure timely service delivery for members.
- Handled sensitive information while maintaining strict confidentiality standards.
- Trained new team members on customer service protocols and software tools.
- Provided customer service by answering inquiries, resolving complaints, and providing general information to clients regarding healthcare services.
- Utilized claims management software to track and document claim progress.
- Processed claims by reviewing documentation and verifying information accuracy.
- Communicated with clients to gather necessary information for claim evaluations.
Education
Associate of Science - Insurance And Risk Management
Maricopa Community College System
AZ06-2027
GED -
Pennsylvania Scholl Of Business
Allentown06-2010
Skills
- Medical Claims & Insurance
- Claims processing
- Customer service
- Claims management
- CRM software
- Medical terminology
- Electronic authorization processing
- Patient communication
- Data entry
- Medical billing
- Proficient in EHR
Certification
- Certified Medical Reimbursement Specialist (CMRS), AMBA
- HIPAA Compliance & Data Privacy, 2023
Timeline
Insurance Specialist II
Kelly Services
05.2024 - Current
Insurance/Medical Billing Specialist
Family Practice Center PC
06.2022 - 10.2023
Front Desk Receptionist
Dental Dreams LLC
03.2020 - 06.2022
Claims Customer Service Representative
PMA Companies
04.2016 - 05.2020
Healthcare Customer Service Representative
Aetna Health Insurance
04.2012 - 03.2016
Associate of Science - Insurance And Risk Management
Maricopa Community College System
GED -
Pennsylvania Scholl Of Business