Sakeina Keene

• Skilled at working independently and collaboratively in a team environment.
• Self-motivated, with a strong sense of personal responsibility.
• Excellent communication skills, both verbal and written.
• Paid attention to detail while completing assignments.
• Streamlined prior authorization processes by implementing efficient tracking systems.
• Coordinated with billing department to resolve discrepancies related to denied claims due to incomplete or incorrect prior authorizations.
• Monitored pending cases closely, proactively following up on outstanding documentation needed for successful approval outcomes.
• Maintained organized records and up-to-date files for all completed and pending authorization requests, ensuring easy access during audits or reviews.
• Input all patient data regarding claims and prior authorizations into system accurately.
• Analyzed medical records and other documents to determine approval of requests for authorization.
• Responded to inquiries from healthcare providers regarding prior authorization requests.
• Verified eligibility and compliance with authorization requirements for service providers.
• Fielded telephone inquiries on authorization details from plan members and medical staff.
• Tracked referral submission during facilitation of prior authorization issuance.
• Checked data input and verified totals on forms prepared by others to detect errors in arithmetic, data entry or procedures.
• Completed data entry and filing to keep records updated for easy retrieval.
• Completed data entry of enrollments and case-management activities.
• Completed variety of purchasing and associated data entry tasks on complex, time-sensitive schedule.
• Collected, arranged, and input information into database system.
• Collaborated with cross-functional teams to resolve complex claims issues efficiently and effectively.
• Managed high volume of claims, prioritizing tasks to meet deadlines without sacrificing quality.
• Maintained strict confidentiality when dealing with sensitive information about patients'' medical histories or personal details.
• Utilized specialized software to process incoming claims, enter data and generate reports.
• Reviewed applications and supporting documents to verify claims eligibility and accuracy.
• Maintained strong knowledge of basic medical terminology to better understand services and procedures.
• Verified resubmitted claims after denial to achieve financial targets and reduce outstanding debt.
• Managed a high volume of Medicare claims, ensuring timely submission and payment for medical services rendered.
• Collaborated with healthcare providers to obtain necessary documentation for accurate Medicare billing.
• Assisted in maintaining HIPAA compliance, safeguarding patient information during the billing process.
• Accurately entered patient demographic and billing information in billing system to enable tracking history and maintain accurate records.
• Reviewed patient diagnosis codes to verify accuracy and completeness.
• Filed and updated patient information and medical records.
• Collaborated closely with healthcare providers to ensure accurate billing and coding practices.
• Managed time efficiently in order to complete all tasks within deadlines.
• Passionate about learning and committed to continual improvement. Proficient in learning new concepts quickly and efficiently.
• Used critical thinking to identify issues with submitted claims to relay back to Providers so they could resubmit the claim.

( Laid off due to budget cuts to Contingency Workers)

• Handled customer inquiries and suggestions courteously and professionally.
• Actively listened to customers, handled concerns quickly and escalated major issues to supervisor.
• Answered constant flow of customer calls with minimal wait times.
• Answered customer telephone calls promptly to avoid on-hold wait times.
• Offered advice and assistance to customers, paying attention to special needs or wants.
• Clarified customer issues and determined root cause of problems to resolve product or service complaints.
• Responded to customer requests for products, services, and company information.
• Participated in team meetings and training sessions to stay informed about product updates and changes.
• Tracked customer service cases and updated service software with customer information.

( Laid off due to Budget cuts)

• Demonstrated self-reliance by meeting and exceeding workflow needs
• Provided excellent service and attention to customers when face-to-face or through phone conversations
• Handle a minimum of 50 inbound/outbound calls daily
• Resolved interpersonal conflicts by listening, finding common ground and building relationships
• Placed Prescription orders, provided Rx delivery status
• Submitted Prior Authorization Requests to Doctors Office
• Improved customer service waiting times to mitigate complaints
• De-escalated problematic customer concerns, maintaining calm, friendly demeanor
• Documented customer correspondence in CRM to track requests, problems and solutions
• Asked probing questions to determine service needs and accurately input information into electronic systems
• Explained benefits, features and recommendations to maximize client retention.
• Analyzed and evaluated existing compensation and benefits programs and recommended improvements.

(Left for better opportunity with CVS)

• Accommodated customer allergies and dietary restrictions by modifying standard recipes
• Trained and guided new kitchen staff
• Inspected foods throughout each shift, verifying quality and attractiveness of each plate Monitored sanitation practices to ensure, food quality and safety
• Had a daughter before this position and managed a Subway for several years, relocated to Pittsburgh and managed a California Pizza kitchen for 4 years

(Left for better opportunity)

• Supervised and coordinated activities of cooks or workers engaged in food preparation
• Facilitated flow of order delivery by delegating tasks to kitchen staff
• Enforced adherence to food safety regulations and best practices across kitchen staff
• Trained and guided new employees

(Left for better pay with California Pizza Kitchen)

• Controlled risks of unauthorized access and behaviors by carefully overseeing entrances and exits
• Managed daily reporting for routine activities and notable incidents such as breaches, medical emergencies, and damage
• Locked doors and gates of entrances and exits to secure buildings Identified security issues with foot patrols of building and grounds.
• Responded quickly to incidents and assessed active situations for security concerns.
• Verified each individual's right to enter restricted areas and denied access to unauthorized persons.

(Left because she relocated to Pittsburgh)

• Overcame customers' objections with use of skilled persuasion techniques, product knowledge, and pre-written scripts
• Maintained detailed records of interactions for future follow-up on denials
• Pursued customers through extent of available options with tenacious dedication to closing sales Had a new born child after high school, took two years to raise her before starting position at Sears
• Answered questions about company offerings with knowledgeable responses about products and services.
• Built relationships with customers using strong persuasion and active listening skills.