LAVOTIA MCKENZIE
Amerimed EMS
Lawrenceville,GA
15
years of professional experience
Thorough and dependable Claims Specialist with 5+ years of experience analyzing, processing, and adjudicating healthcare and disability claims with accuracy, speed, and regulatory compliance. Adept at navigating complex policy documents, resolving eligibility discrepancies, and collaborating with internal teams to drive timely resolutions. Proficient in high-volume environments with strong documentation practices, data entry accuracy, and a customer-first mindset. Committed to delivering fair, efficient, and consistent claims handling while meeting or exceeding performance benchmarks.
Work History
Insurance Verification Specialist
1 Year 1 Month- Conduct full-spectrum insurance verification across commercial payers, Medicaid, and Medicare, confirming active coverage, plan details, policy limitations, copay/deductibles, and authorization/pre-certification requirements for EMS transport services
- Prepare and submit clean, compliant HCFA/UB-04 claims through electronic systems such as Epic, Meditech, Availity, and payer-specific portals
- Oversee end-to-end claims management, including timely submission, monitoring for rejections/denials, and initiating corrections or appeals as necessary
- Execute payment posting and reconcile remittances (EOBs/EOPs) to ensure proper allocation and tracking of patient and insurance payments
- Manage Accounts Receivable (AR) workflows with a focus on reducing Days in AR, increasing cash collections, and improving claim resolution rates
- Identify trends in denials, underpayments, and authorization issues to escalate and resolve root causes with internal teams or payer representatives
- Collaborate closely with dispatchers, coders, and medical staff to ensure claims accuracy and regulatory compliance for EMS transport billing
- Serve as a primary contact for patients and insurance carriers, professionally handling inquiries regarding billing, claims status, balances, and benefit coverage
- Maintain accurate documentation and follow strict HIPAA guidelines while working independently in a remote environment
Billing & Collections Representative
6 Years 9 Months- Process and adjudicate an average of 150+ medical and disability claims per week, maintaining 98% accuracy across all decisions.
- Review clinical, financial, and policy data to determine claim eligibility and benefit level, consistently meeting departmental SLA goals.
- Collaborate with medical reviewers, vocational experts, and case managers to gather supporting documentation and validate claim decisions.
- Maintain detailed case notes and documentation in internal systems, contributing to full audit compliance and operational transparency.
- Participate in training on evolving state and federal guidelines, ensuring continuous compliance with regulatory standards.
Customer Service Representative
1 Year 1 Month- Handled inbound customer inquiries related to products, services, and orders.
- Ensured prompt resolution of customer concerns while maintaining service excellence.
- Maintained accurate records of customer interactions and transactions.
- Enhanced product visibility and increased service sales by identifying customer needs.
Grievance & Appeals Specialist
3 Years 4 Months- Reviewed, processed, and resolved member appeals and grievances.
- Verified client details and reviewed medical documentation.
- Ensured claims were properly submitted, corrected, and resubmitted for approval.
- Maintained high accuracy in documentation and compliance with HIPAA.
Mail Clerk / Office Support
1 Year 8 Months- Routed correspondence, organized supply inventory, and supported office workflow.
- Operated processing equipment and ensured secure delivery of registered mail.
- Maintained internal tracking and documentation for all received and outgoing mail.
Education
Associate of Science
Skills
Claims Processing | Health Insurance Knowledge | Medical Terminology | Data Entry Accuracy | SLA Management | Claims Adjudication | Eligibility Verification | Regulatory Compliance | Decision Making | Claim Documentation | Attention to Detail | Remote Collaboration | Workflow Management | Claims Lifecycle | Internal Communication | HIPAA
Timeline
Insurance Verification Specialist
Amerimed EMS
05.2024 - 06.2025Read More
Billing & Collections Representative
Change Healthcare
06.2016 - 03.2023Read More
Customer Service Representative
Walgreens
04.2014 - 05.2015Read More
Mail Clerk / Office Support
United States Postal Service
07.2011 - 03.2013Read More
Grievance & Appeals Specialist
United Healthcare Group
08.2010 - 12.2013Read More
Florida Agricultural and Mechanical University
Associate of Science
Read More