LaKeisha Gaston
Lancaster
Summary
An ambitious detail-oriented and results-driven professional with years of experience in healthcare quality assurance, financial services, and customer support. Adept at analyzing data, improving operational efficiency, ensuring compliance with regulations, and delivering exceptional service. Seeking to leverage expertise in quality management, patient access, and financial operations to contribute to a dynamic team.
Overview
15
15
years of professional experience
1
1
Certification
Work History
Quality Analyst
AmerisourceBergen (Lash Group)
09.2019 - 06.2024
- Conducted quality reviews of patient and program records through call monitoring, case file reviews, and audits to ensure compliance with SOPs
- Updated SOPs and uploaded to shared Pilgrim Database
- Provided feedback to management teams on trends and opportunities for improvement, with an emphasis on quality metrics, accuracy, and adverse events
- Identified areas for process improvement based on data analysis and collaborated with healthcare teams to implement changes
- Assisted in the development of quality procedures, performance improvement initiatives, and monitoring tools such as Power BI and SQL for data analysis
- Trained staff on quality standards, policies, and best practices to ensure continuous improvement
- Managed performance audits and collaborated on process optimization
- Analyzed quality and performance data to support operational decision-making
- Created and revised procedures, checklists and job aids to reduce errors
- Completed Monthly Client Calibration Sessions regarding calls and process improvements
Senior Reimbursement Counselor (Patient Access Specialist)
AmerisourceBergen (Lash Group)
10.2017 - 09.2019
- Provided advanced services to patients, providers, and caregivers, including benefit verification, coordination of benefits, and alternate coverage research
- Ensured compliance with healthcare regulations and reported any adverse events as directed
- Assisted with claims submission, prior authorization, billing, and coding support
- Coordinated services within SLA parameters and maintained a high level of customer service
- Completed Pharmacy Overrides via PDMI
- Assisted with Provider Portal and Live Chat
- Worked directly with patients to facilitate resolution of coverage issues, ensuring seamless access to medications
- Reduced claim denials for better revenue recovery through meticulous review of documentation and adherence to regulations
- Completed Fusion Training along with participating in Design Lab to create Database specific to Program
- Coordinated and completed Client Sit-Ins related to workflow processes
- Led training for new associates and provided expertise in handling complex reimbursement scenarios
Site Coordinator
AmerisourceBergen (Lash Group)
09.2016 - 09.2017
- Assisted provider office staff and patients in completing and submitting enrollment forms and maintaining patient confidentiality
- Managed customer service and administrative tasks to ensure a smooth workflow and timely issue resolution
- Coordinated shipments and communications between specialty pharmacies and patients
- Promoted a culture of continuous improvement within the team, encouraging input from all members for process optimization purposes
- Developed strong relationships with clients, ensuring timely completion of tasks and adherence to guidelines
- Maintained frequent phone contact with provider representatives, third party customer service representatives, pharmacy staff, and patients
- Maintained confidentiality in regards to patient information
- Gathered and verified all required customer information for HIPAA purposes
Benefit Verification Specialist
AmerisourceBergen (Lash Group)
05.2015 - 09.2016
- Collected and verified patient insurance information to ensure medication coverage
- Managed coordination of benefits and communicated directly with payers to resolve discrepancies
- Processed all necessary insurance documentation and facilitated access to prescription drug coverage
- Tracked insurance trends and reported findings to management to improve program efficiency
- Provided exceptional customer service by addressing patient concerns regarding coverage and out-of-pocket expenses.
- Managed high-volume caseloads while maintaining strict deadlines for completing benefit verifications and authorizations.
- Ensured compliance with HIPAA regulations during all aspects of the benefit verification process, protecting patient privacy
Patient Case Coordinator
AmerisourceBergen (Lash Group)
07.2013 - 05.2015
- Managed patient cases, coordinated shipments, and addressed inquiries regarding programs and medications
- Maintained constant communication with patients, ensuring timely case updates and shipping details
- Accurately documented all interactions and processed program enrollment forms
- Increased patient satisfaction by addressing concerns promptly and providing comprehensive information on treatment plans
- Enhanced patient care by efficiently managing case files, ensuring timely updates and coordination among medical professionals
- Answered average of 55 calls per day by addressing patient inquiries, solving problems and providing any updates
- Triaged inbound calls to appropriate departments when necessary
Data Intake Specialist
AmerisourceBergen (Lash Group)
02.2012 - 07.2013
- Handled distribution and data-entry of sensitive patient information, ensuring HIPAA compliance
- Managed incoming enrollment forms and maintained accurate records
- Managed distribution of many pharmaceutical documents(approximately 250 daily.)
- Entered numerical data into several databases in timely and accurate manner
Quality Review Specialist
AmerisourceBergen (Lash Group)
07.2011 - 02.2012
- Maintained close interface with all components of case management to ensure information was correctly obtained, documented in detail, tracked, and made available for access to complete quality reviews
- Reviewed cases to ensure accurate documentation and compliance before orders were sent to Specialty Pharmacy for.shipment of orders
- Worked closely with case management to resolve quality issues and maintain data integrity
- Contributed to continuous improvement initiatives by participating in process assessments and offering actionable suggestions for enhancement opportunities
Retail Banker
Woodforest National Bank
06.2009 - 07.2011
- Processed customer transactions, managed loan applications, and handled accounts(opened-closed)
- Ensured compliance with bank procedures and provided exceptional customer service
- Executed customer transactions: including deposits, withdrawals, money orders, and checks
- Followed up with customers regarding past due accounts
- Conducted quarterly vault and ATM audits
- Strengthened client portfolio by identifying needs and recommending/marketing suitable financial products or services
- Complied with regulatory, legal and ethical requirements to protect bank assets
Education
Associate of Science - Science
University of South Carolina
Lancaster, SC05-2006
Skills
- Virtual Remote Work(Self Starter)
- Identified as a Subject Matter Expert
- Keen Eye for Detail and Accuracy
- Results and Deadline-Driven
- Workload/Time Management
- Rapid Data Entry
- HIPAA/PHI Compliance
- Familiarity with State/Local Healthcare Regulations
- Proficient in MS Office Suite(Word, Outlook, Teams, PowerPoint, Excel, Sharepoint, Salesforce, SQL, Power BI, Etc)
- Electronic Health Records(EHR)
- Standard Operational Procedures(SOP) Development/Procedural Updates
- Data/Root-Cause Analysis
- Audit/Quality Improvement Processes
- Daily/Weekly/Monthly Maintenance Validations
- Report Creation and Presentation
- Training Material Development
- Medical Terminology
- Billing & Coding(ICD-!0, CPT Codes)
- Claims Assistance
- Reimbursement Processes
- Exceptional Workflow Optimization
- Excellent Communication(Written/Verbal)
- Performance Assessment
- Project Management Expertise
- Developing Quality Standards
- Team Mentoring
- Training and Onboarding Associates
- Team Collaboration
Certification
Lean Six Sigma Certification
Professional Development
- Fusion Database Development Training
- Performance Management Software Training
Timeline
Quality Analyst
AmerisourceBergen (Lash Group)
09.2019 - 06.2024
Senior Reimbursement Counselor (Patient Access Specialist)
AmerisourceBergen (Lash Group)
10.2017 - 09.2019
Site Coordinator
AmerisourceBergen (Lash Group)
09.2016 - 09.2017
Benefit Verification Specialist
AmerisourceBergen (Lash Group)
05.2015 - 09.2016
Patient Case Coordinator
AmerisourceBergen (Lash Group)
07.2013 - 05.2015
Data Intake Specialist
AmerisourceBergen (Lash Group)
02.2012 - 07.2013
Quality Review Specialist
AmerisourceBergen (Lash Group)
07.2011 - 02.2012
Retail Banker
Woodforest National Bank
06.2009 - 07.2011
Associate of Science - Science
University of South Carolina
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