Shekia Lynch
Orlando,FL
Summary
- Seasoned Benefits Verification Specialist with 9 years of experience in verifying benefits, obtaining prior authorizations, and managing insurance correspondences.
- Extensive experience with checking member’s eligibility, verifying insurance, processing co-pays and performing data entry.
- Experience in problem solving issues during first call with members.
- Proficient with software like EMR experience- Eclinnical, MS Word, Excel and Outlook.
- Skilled with ICD9/10, CPT, 10 key entry and Medical Terminology. Skilled in utilizing industry-standard portals such as Availity and Healthfirst for payor follow-ups and documentation.
Cordial Patient Access Representative with extensive track record of successfully handling busy medical office tasks to serve diverse populations. Career-minded and organized professional skillful in maintaining patient accounts, arranging immediate medical care and verifying insurance claims. Familiar with medical and clinical terminology coupled with proficiency in MS Office.Dedicated employee known for punctuality, pursuing employment options where good customer service and positive attitude will make a difference.
Overview
7
7
years of professional experience
Work History
Patient Access Specialist
AssistRX
09.2024 - Current
- Answer inbound calls in a timely manner
- Experience in Salesforce (9 years)
- Investigate patients benefits
- Answer all questions from patients, prescribers and pharmacists for medication dispense
- Research programs for patients if they are denied
- Follow through with open cases and set tasks for CM
- Perform other related duties that are assigned by management
- Provide approvals or denial to patients
- Fax Appeal letter, Approval letters to patients, HCP
- Check all income documents, make sure FPL is within approval stage
- Explained policies, procedures and services to patients.
- Organized timely and accurate referrals to help patients obtain health care services and access available resources.
- Applied knowledge of payer requirements and utilized on-line eligibility systems to verify patient coverage and policy limitations.
- Resolved issues related to registration process including eligibility verification and authorization problems.
Medical records Audit Specialist
Datavant
03.2024 - 09.2024
- Pulled charts Daily for accuracy (95-250 charts daily)
- Evaluate Diagnosis and procedure coding accuracy
- Ensure medical records are assembled in order and accurate and complete
- Processing all release of information in a timely manner
- Meet required metrics Charts Per Hour (CPH)
- Navigate various provider EMR and file systems in the medical chart patient list
Verification of Benefits
Abbott
11.2020 - 11.2023
- Company Overview: Part of company Layoff
- Verified member benefits and eligibility to ensure compliance with healthcare policy requirements
- Managed prior authorization processes for durable medical equipment (DME) and Left Ventricular Assist Device (LVAD) supplies, enhancing patient access to necessary healthcare resources
- Coordinated insurance correspondences, including the submission of appeals and maintenance of documentation, to support effective patient advocacy
- Discuss cost of service, insurance coverage, and payment options with the patient
- Provide community resources and referrals for continuing care
- Get prior authorizations for procedures
- Part of company Layoff
Payor Follow Ups
03.2020 - 11.2020
- Company Overview: Temp
- Conducted thorough follow-up on pending authorizations with various health plans to ensure timely approvals, effectively maintaining and updating records for accuracy
- Streamlined documentation processes by securing and confirming authorization approvals, enhancing operational workflow
- Uploaded clinical records to multiple healthcare portals, including Availity and Healthfirst, ensuring compliance and accessibility of patient information
- Temp
Patient Care Coordinator
ACS (Advanced Care Scripts)
09.2019 - 02.2020
- Company Overview: Assessment Team (Temp)
- Managed a high volume of inbound and outbound calls, averaging 75 to 100 daily, to support patients with enrollment and follow-up in financial assistance programs
- Addressed patient inquiries related to copay assistance, providing timely status updates and approval information
- Conducted thorough research and analysis of patient accounts to resolve questions and concerns regarding enrollment in assistance programs
- Efficiently processed patient prescription refill requests as needed, consistently exceeding the daily quota by handling 150 accounts
- Discuss cost of service, insurance coverage, and payment options with the patient
- Scan documents into patient charts
- Work as a team player to ensure each patient receives the best service possible
- Assessment Team (Temp)
Eligibility Associate
Express Scripts
Orlando, USA
11.2017 - 03.2018
- Company Overview: Orlando, FL
- Handled 200+ inbound calls from patients a day
- Responsibilities included checking member’s eligibility, and verifying insurance
- Entered patient’s health insurance information into Citrix (software)
- Completed A/R invoices
- Used 10 key entry daily
- Orlando, FL
Education
Associate Degree - Business Administration
American Intercontinental University
08.2000
Skills
- Medical terminology
- Co-payment collection
- Authorization verification
- Eligibility determination
- EMR
- Insurance information collection
- Healthcare software
- Exceptional communication
- Appointment scheduling
- Performance standards compliance
- Documentation accuracy
- Patient registration
- HIPAA compliance
- Formularies
- Professionalism and ethics
- Insurance billing
- Medical terminology expertise
- Health information obtainment
- Data entry proficiency
- Financial obligation determination
- Patient scheduling
- Insurance verification
- Information collection
- Front desk operations
- Healthcare reimbursements
- Specialist referrals
- Patient interviewing
Interviewavailability
Open
Timeline
Patient Access Specialist
AssistRX
09.2024 - Current
Medical records Audit Specialist
Datavant
03.2024 - 09.2024
Verification of Benefits
Abbott
11.2020 - 11.2023
Payor Follow Ups
03.2020 - 11.2020
Patient Care Coordinator
ACS (Advanced Care Scripts)
09.2019 - 02.2020
Eligibility Associate
Express Scripts
11.2017 - 03.2018
Associate Degree - Business Administration
American Intercontinental University