Sakeina Keene
Pittsburgh,PA
Summary
Health Plan Specialist at Life Pittsburgh with a successful track record in managing medical authorizations and reviewing claims. Skillful in entering new enrollments into Plexis and ensuring accurate and up-to-date information. Expertise in compiling enrollment forms for state review and collaborating with various departments. Proficient in checking EHR for appointments and service orders to verify claims accuracy. Experienced in handling Durable Medical Equipment authorizations for a wide range of services and supplies. Diligent in checking claim statuses, resolving pending claims, and ensuring correct coding. Detail-oriented and proficient in Microsoft Office suite. Strong organizational skills and ability to handle multiple projects simultaneously. Call center experience with excellent oral and written communication skills. Dedicated and passionate about helping people.
Overview
16
16
years of professional experience
Work History
Health Plan Specialist
Life Pittsburgh
11.2023 - 06.2024
- Coordinated with billing department to resolve discrepancies related to denied claims.
- Monitored pending cases closely, proactively following up on outstanding documentation needed. Keeping them at or below 50
- Maintained organized records and up-to-date files for all completed and pending authorization requests.
- Input all patient data regarding claims and prior authorizations into the system accurately
- Analyzed medical records and other documents to determine approval of requests for authorization
- Verified eligibility and compliance with authorization requirements for service providers
- Completed a variety of purchasing and associated data-entry tasks for over 500 participants.
- Managed a high volume of claims, prioritizing tasks to meet deadlines without sacrificing quality
- Utilized specialized software to process incoming claims, enter data, and generate reports
- Reviewed applications and supporting documents to verify claims eligibility and accuracy
- 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
- Assisted in maintaining HIPAA compliance, safeguarding patient information during the billing process
Customer Service Representative
Highmark Wholecare
10.2022 - 10.2023
- Handled customer inquiries and suggestions courteously and professionally
- Actively listened to customers, handled concerns quickly, and escalated major issues to the supervisor
- Answered a constant flow of customer calls with minimal wait times
- Clarified customer issues and determined the root cause of problems to resolve product or service complaints
- 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.
Prescription Benefit Specialist
CVS Caremark
07.2021 - 06.2022
- Provided excellent service and attention to customers when face-to-face or through phone conversations
- Handled a minimum of 50 inbound/outbound calls daily
- Placed Prescription orders, and provided Rx delivery status
- Submitted Prior Authorization Requests to the Doctors' Office
- Improved customer service waiting times to mitigate complaints
- De-escalated problematic customer concerns, maintaining a 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
Kitchen Chef
Cheesecake Factory
04.2015 - 07.2021
- 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.
Chef
California Pizza Kitchen
12.2010 - 04.2015
- 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.
Unarmed Security Guard
Valor Security
02.2010 - 12.2010
- 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.
Telemarketer Sales Representative
Sears Holdings
11.2008 - 01.2010
- 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
- Answered questions about company offerings with knowledgeable responses about products and services
- Built relationships with customers using strong persuasion and active listening skills.
Education
High School Diploma -
Trinity 1 | Trinity Christian High
Morgantown, WV05.2006
Skills
- MS Office
- Customer Service
- Conflict Resolution
- Plexis
- EHR
- HIPAA Compliance
- Insurance Verification
- Claims Processing
- SQL
- Data Entry
- Active Listening
- Insurance Eligibility
- Teamwork and Collaboration
- Account Management
- Call Center Operations
- Excel
- Salesforce
- Sage Intacct
- Power Bi
Gliderlink
https://hire.glider.ai/auth/reviewer/f7CwRAuen2BNTbphr/Me ERD7B4DK3N2BvEt /ojynHEKHdear22ZPK/type/62c5ec045a007552b60bcd3d/default
Conversionsalary
$20.70
Timeline
Health Plan Specialist
Life Pittsburgh
11.2023 - 06.2024
Customer Service Representative
Highmark Wholecare
10.2022 - 10.2023
Prescription Benefit Specialist
CVS Caremark
07.2021 - 06.2022
Kitchen Chef
Cheesecake Factory
04.2015 - 07.2021
Chef
California Pizza Kitchen
12.2010 - 04.2015
Unarmed Security Guard
Valor Security
02.2010 - 12.2010
Telemarketer Sales Representative
Sears Holdings
11.2008 - 01.2010
High School Diploma -
Trinity 1 | Trinity Christian High
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