Lakitha Bradsher
Summary
Professional with significant expertise in medical claims examination, adept at meticulous claim assessments and thorough analysis to ensure accurate and timely processing. Strong focus on team collaboration and achieving results, adaptable to dynamic environments. Well-versed in regulatory compliance, claims adjudication, and effective communication. Dependable and flexible, consistently delivering high-quality outcomes in fast-paced setting.
Overview
10
10
years of professional experience
Work History
Remote Senior Claims Examiner
United Healthcare
Remote
12.2024 - Current
- Led complex claims investigations to ensure compliance with regulatory standards and company policies.
- Negotiated settlements with claimants, balancing fairness with fiscal responsibility to the company.
- Mentored junior examiners, providing training on best practices in claims processing and dispute resolution.
- Analyzed medical claims to ensure compliance with policies and regulations.
- Developed expertise in specialized areas such as workers'' compensation or disability claims management to better serve diverse client needs.
Patient Access Representative
Baptist Health / Jacksonville Orthopedic Institute
Remote
08.2022 - 12.2024
- Streamlined patient registration processes, enhancing efficiency and reducing wait times.
- Managed insurance verification, ensuring accurate billing and minimizing claim denials.
- Adapted quickly to changing demands within the healthcare environment, demonstrating flexibility and a strong commitment to quality patient care.
- Ensured compliance with HIPAA regulations to maintain confidentiality of sensitive patient information during all interactions.
- Managed appointment scheduling and coordinated with clinical staff to optimize patient flow.
Claims Benefit Specialist
CVS Health
Remote
06.2022 - 01.2024
- Evaluated and processed claims to ensure compliance with policy guidelines and regulations.
- Analyzed claims data to determine eligibility and benefits for clients.
- Maintained up-to-date knowledge on industry regulations and guidelines, ensuring compliance throughout the claims process.
- Supported management in identifying areas of potential cost savings through the evaluation and implementation of alternative claim resolution strategies.
Claims Intermediary I
One Call Management
Jacksonville, FL
09.2020 - 10.2022
- Process payments for Non Emergency transportation claims.
- Analyzed claim documentation to determine coverage and eligibility.
- Request documentation to support medical necessity for Ambulance Transportation.
- Answer inquires from patients and provider requesting payment details.
- Worked effectively in fast-paced environments.
Patient Service Representative/Medical Records
Family Care Partners
Jacksonville, FL
11.2016 - 08.2020
- Facilitated patient appointments and coordinated scheduling to enhance clinic efficiency.
- Managed patient inquiries and provided comprehensive information on services and procedures.
- Processed insurance authorizations and verified eligibility to ensure seamless patient care.
- Improved patient check-in process, reducing wait times and enhancing overall experience.
Education
High School Diploma -
Fields of Art Christian Academy
Jacksonville, FLSkills
- Medicare and Medicaid Knowledge
- HIPAA Compliance Awareness
- Insurance Verification
- Patient Registration
- HCPCS coding
- Benefits Coverage
- Customer Service
- Inbound and Outbound Calling
- Claims Processing
- Appeals handling
- ICD-10 proficiency
- Call Center Experience
Timeline
Remote Senior Claims Examiner
United Healthcare
12.2024 - Current
Patient Access Representative
Baptist Health / Jacksonville Orthopedic Institute
08.2022 - 12.2024
Claims Benefit Specialist
CVS Health
06.2022 - 01.2024
Claims Intermediary I
One Call Management
09.2020 - 10.2022
Patient Service Representative/Medical Records
Family Care Partners
11.2016 - 08.2020
High School Diploma -
Fields of Art Christian Academy