La'Quan Robinson
Raleigh,NC
Summary
Dedicated Reimbursement Case Manager skilled in claim eligibility analysis and records management. Excellent communication and interpersonal skills. Familiar with industry standards and requirements. Managing duties to facilitate smooth workflow and operational efficiency.
Overview
10
10
years of professional experience
Work History
Reimbursement Case Manager / Intake Specialist
Trial Card
Morrisville, NC
05.2021 - Current
- Verified patients' eligibility and claims status with government, commercial, private insurance companies, and pharmacy benefits payers
- Determined and initiated prior authorizations for Providers via CMM (covermymeds)
- Conducted research to determine claim discrepancies and recommending most viable solution
- Actively maintained current working knowledge of CPT codes
- Generated co-pay assistance cards, and vouchers to specialty pharmacies for prescription
- Established and sustained working relationships with provider offices in entire region of three to five states
- Pulled inbound faxes from Providers, Specialty Pharmacies, and Patients to transcribe them over to SalesForce CRM system.
- Liaised between clients and healthcare providers to maintain continuity of care
- Trained and supervised new intake staff to deliver high-quality client care
- Facilitated communication between clients and other service providers
- Streamlined intake systems, resulting in reduced errors and improved speed
Project Manager / Sales Representative/Insurance specialist
Elysian Construction- Garner
Minneapolis, MN
11.2019 - Current
- Responsible for negotiating with insurance and customer contracts and making sure construction projects are built to NC/MN local and state codes and guidelines
- Demonstrated vital role with making sure construction projects are completed efficiently and on time, as well as within budget
- Increased commercial and private homeowner sales by over 20%
- Led weekly production sales and operations meetings in order to facilitate stronger communication and resolve critical issues
- Identified as main point of contact in charge of constructing work plans for commercial and residential project development
- Provided subject matter expertise in managing project scope, and contingency plans
Inter
Blue Cross and Blue Shield of NC, Plan Service Host
Durham, North Carolina
09.2019 - 11.2019
- Identified as main point of contact for internal/external inquiries regarding medical claims adjudications
- Navigated and toggled multiple service platforms to search and update providers on medical claims, including Facets, Oracle, and Power MHS
- Manually priced claims to ensure all medical policies and guidelines were followed in process
- Managed over 30 customer calls per day
- Reviewed all inbound documents to assist with making most efficient decisions during claim adjudications
- Recognized problems, gaps, and inconsistencies in workflows, and recommended updates, alternatives, and solutions
Desktop Support Technician
Peak Systems
New York, NY
02.2017 - 09.2019
- Diagnosed, troubleshot, and resolved hardware, software, or other network and system problems, and replaced defective components as necessary
- Troubleshot network and/or connectivity problems for user groups
- Managed end-user accounts and permissions, overseeing correct provisioning of access rights in accordance with security best practices and policies
- Generated reports to track performance and analyze trends
- Diagnosed and troubleshot hardware, software and network issues
- Maintained servers and systems to keep networks fully operational during peak periods
- Removed malware, ransomware, and other threats from laptops and desktop systems
- Installed, configured and maintained computer systems and network connections
- Tested new software and hardware prior to deployment
- Helped streamline repair processes and update procedures for support action consistency
- Authored detailed documentation on service call resolutions, providing valuable data on both personnel performance and effective remediation techniques
Reimbursement Case Specialist / Intake specialist
Biologics
Cary, North Carolina
12.2016 - 09.2019
- Conducted benefit investigations to verify prescription drug coverage for patients and providers
- Answered over 30 phone calls and provided new clients with required paperwork to initiate service
- Assisted with vendor case uploads and updated cases accordingly
- Collected, verified, recorded and processed client demographics, insurance payments, and referral information
- Liaised between clients and healthcare providers to maintain continuity of care
- Maintained accurate, up-to-date client records for reliable reference and communications
Rental Car Manager
Leith Nissan
Cary, North Carolina
01.2014 - 12.2016
- Managed Rental Program with 100+ vehicle fleet
- Used industry expertise, customer service skills and analytical nature to resolve customer concerns and promote loyalty
- Identified and communicated customer needs to supply chain capacity and quality teams
- Maintained professional demeanor by staying calm when addressing unhappy or angry customers
- Trained personnel in equipment maintenance and enforced participation in exercises focused on developing key skills
- Successfully managed budgets and allocated resources to maximize productivity and profitability
- Learned and adapted quickly to new technology and software applications
- Provided professional services and support in dynamic work environment
Customer Service Representative
Convergys
Greenville, North Carolina
12.2012 - 01.2014
- Maintained up-to-date knowledge of new technologies, products, standards, and protocols
- Answered 30 customer telephone calls promptly to avoid on-hold wait times
- Provided excellent customer care by responding to requests, assisting with product selection and handling ordering functions
- Promoted superior experience by addressing customer concerns, demonstrating empathy, and resolving problems swiftly
- Actively listened to customers, handled concerns quickly and escalated major issues to supervisor
- Clarified customer issues and determined root cause of problems to resolve product or service complaints
Education
Economics (BS) -
East Carolina University
Greenville, NC06.2014
High School Diploma -
Jacksonville High School
Jacksonville, NC05.2008
Skills
- Oral and written communication skills
- Teamwork and collaboration
- Project Management
- Leadership
- Critical thinking and problem-solving
- Professionalism and strong work ethic
Timeline
Reimbursement Case Manager / Intake Specialist
Trial Card
05.2021 - Current
Project Manager / Sales Representative/Insurance specialist
Elysian Construction- Garner
11.2019 - Current
Inter
Blue Cross and Blue Shield of NC, Plan Service Host
09.2019 - 11.2019
Desktop Support Technician
Peak Systems
02.2017 - 09.2019
Reimbursement Case Specialist / Intake specialist
Biologics
12.2016 - 09.2019
Rental Car Manager
Leith Nissan
01.2014 - 12.2016
Customer Service Representative
Convergys
12.2012 - 01.2014
Economics (BS) -
East Carolina University
High School Diploma -
Jacksonville High School
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