LENIA M. WEST
Baltimore,MD
Summary
Dynamic healthcare and client support professional with over 20 years of experience in high-volume, regulated environments. Adept at managing complex inquiries and ensuring compliance with strict quality and productivity standards. Expertise in claims processing, including thorough review and validation of insurance claims, with a strong emphasis on accuracy, effective communication, and problem-solving. Recognized for a collaborative approach and exceptional adaptability to evolving needs, fostering seamless operations and achieving organizational goals. Highly skilled in data analysis and proficient in claims software, consistently delivering reliable results in team-oriented settings while committed to excellence.
Overview
13
13
years of professional experience
1
1
Certification
Work History
Pharmacy Claims Processor
IQVIA
Remote Per Diem
01.2023 - Current
- Reviewed and validated high-volume pharmacy claims, maintaining strict adherence to accuracy and compliance protocols.
- Resolved customer inquiries regarding healthcare services and policies, ensuring clarity and satisfaction.
- Processed claims efficiently using proprietary software to ensure accuracy and timely resolution.
- Reviewed claim documentation for completeness, identifying discrepancies and initiating corrections as needed.
Client Management Specialist
Blue Cross Blue Shield Global Solutions (GeoBlue)
Remote
08.2022 - Current
- Managed client accounts, ensuring accurate updates and compliance with company policies.
- Ensured client satisfaction for a diverse range of business books through prompt inquiry resolution and issue management.
- Assessed and confirmed claim documentation and eligibility data to ensure compliance with regulations.
- Analyzed customer complaints to identify root causes and documented findings for resolution.
- Conducted thorough reviews of underwriting and renewal documentation to maintain accuracy and mitigate risk.
- Maintained comprehensive and organized case notes to support compliance and operational integrity.
- Identified and analyzed recurring issues to enhance operational efficiency.
Administrative Assistant
Collaborative Psychiatric Associates
Abington, PA
02.2018 - 09.2022
- Facilitated resolution of patient inquiries related to records, FMLA, and disability forms to ensure compliance and support.
- Performed detailed reviews of patient records to maintain accuracy and uphold HIPAA regulations.
- Validated insurance details to ensure compliance with policy requirements.
- Managed tracking systems to ensure timely and effective follow-up processes.
- Conducted thorough quality checks to ensure data accuracy and integrity.
Global Service Senior
GeoBlue
Remote
12.2017 - 08.2022
- Worked effectively in fast-paced environments. Managed over 50 customer calls per day
- Developed and organized billing documentation in Salesforce to enhance accuracy and efficiency.
- Conducted thorough QA assessments on various case queues to maintain high standards of service delivery.
- Contributed to leadership case reviews aimed at improving operational strategies.
- Guided new employees in understanding and implementing documentation standards effectively.
- Exhibited strong personal responsibility to drive project success and team collaboration.
Pharmacy Patient Coordinator
Option Care Infusion
Plymouth Meeting, PA
11.2012 - 12.2017
- Directed patient intake operations to maintain accurate records and adhere to regulatory standards.
- Conducted thorough reviews of records to maintain data integrity.
- Managed patient scheduling and appointment logistics to improve operational efficiency.
- Managed documentation processes for Medicare Part D and ICD-9 to support regulatory adherence and operational efficiency.
Education
Associate of Science - Accounting
Montgomery County Community College
Blue Bell, PABachelor of Arts - Human Biology
Temple University
Philadelphia, PASkills
- High-Volume Call Handling (Inbound/Outbound)
- Customer Service & De-escalation
- Case Documentation & Data Accuracy
- Eligibility & Benefits Verification
- Claims & Billing Support
- Quality Assurance & Compliance (HIPAA)
- Policy & Procedure Adherence
- Multi-System Navigation
- Professional Communication
- Escalation Resolution
Websites
Certification
Certified Pharmacy Technician (Active) — PTCB #32010150755296
Timeline
Pharmacy Claims Processor
IQVIA
01.2023 - Current
Client Management Specialist
Blue Cross Blue Shield Global Solutions (GeoBlue)
08.2022 - Current
Administrative Assistant
Collaborative Psychiatric Associates
02.2018 - 09.2022
Global Service Senior
GeoBlue
12.2017 - 08.2022
Pharmacy Patient Coordinator
Option Care Infusion
11.2012 - 12.2017
Associate of Science - Accounting
Montgomery County Community College
Bachelor of Arts - Human Biology
Temple University