Tomekia Lenoir
MELBOURNE
Summary
Program Specialist II supporting patients and business partners through benefits research, case investigations, and reimbursement guidance. Manages 100 patient calls weekly, handling insurance coverage, out-of-pocket cost questions, prior authorization support, and patient assistance applications while entering orders, change orders, and case notes accurately. Strengthens access to care by locating alternate reimbursement resources, resolving payment denials, and following up on time-sensitive requests.
Overview
13
13
years of professional experience
Work History
Program Specialist II
Eversana
Remote, US
04.2022 - Current
- Handle 100 patient calls weekly with personalized support through phone and online portal channels.
- Investigate insurance benefits and explain coverage, out-of-pocket costs, and reimbursement questions clearly to patients.
- Support prior authorization and medical necessity reviews while coordinating claim denial, payment, and appeals follow-up.
- Enter orders, change orders, and customer notes accurately while maintaining required logs and records.
- Perform outbound calls to gather missing information and move transactions forward without delay.
- Search for alternate reimbursement resources, including state and federal assistance programs, and help qualified patients enroll.
Patient Service Representative
TalentBridge
Remote, US
11.2020 - 03.2022
- Completed 40 member scheduling calls per shift while addressing insurance-provider appointment needs.
- Documented member input and special needs accurately in computer-based systems to support coordinated care.
- Handled inbound program inquiries, enrollment activities, and access coordination with patients, providers, and caregivers.
- Evaluated support program eligibility for copay, PAP, and Medicaid cases while gathering missing information.
- Resolved claim denials and underpayments through payer follow-up, escalation management, and reimbursement issue resolution.
- Supported prior authorization, pharmacy triage, and adverse event reporting across follow-up cases.
Members Relations Representative
Firstsource Health Plans and HealthCare Services
Palm Bay, FL
08.2020 - 10.2020
- Documented member concerns and special needs accurately in computer-based records.
- Used Windows-based systems to retrieve information and support timely customer service.
- Applied active listening to address objections and keep members informed and supported.
- Operated telephones and computers to complete outreach and service tasks efficiently.
- Supported member scheduling coordination by making outbound calls on behalf of insurance providers.
CNA
AVANTE GROUP
MELBOURNE, FL
05.2020 - 08.2020
- Administered physician- and nurse-directed treatments, including catheterizations, enemas, irrigations, suppositories, massages, and douches.
- Applied clean dressings, slings, stockings, and support bandages while following nurse and physician instructions.
- Recorded patient progress, conditions, and care tasks in EHR systems, aligning documentation with HIPAA compliance.
- Monitored pulse, temperature, and respiration, then reported changes in condition to supervisors or case managers.
- Assisted with transfers, bathing, dressing, and grooming while keeping linens, laundry, and personal spaces clean.
CNA
BAY BREEZE SENIOR LIVING AND REHABILITATION CENTER
GULF BREEZE, FL
01.2020 - 04.2020
- Administered treatments and bedside care under nurse or physician direction, including catheterizations, enemas, and support bandages.
- Monitored pulse, temperature, and respiration, then reported changes in patient condition to the supervisor or case manager.
- Documented patient progress, services performed, and care concerns to support ongoing shifts and handoffs.
- Assisted patients with transfers, dressing, grooming, and ambulation while maintaining dignity and comfort.
- Maintained clean rooms and patient belongings by changing linens, washing laundry, and supporting daily personal care.
CUSTOMER SERVICE AGENT for Cigna Healthcare
MANPOWER STAFFING
MELBOURNE, FL
01.2019 - 01.2019
- Answered inquiries about schedules, accommodations, procedures, and policies with clear, patient-focused communication.
- Coordinated appointments, cancellations, and physician order requests while guiding members to in-network facility options.
- Provided authorization approval information and supported prior authorization questions for members and physician offices.
- Documented member interactions in CRM systems and maintained accurate records for follow-up and case review.
- Applied HIPAA-compliant handling when resolving reimbursement issues, escalations, and member assistance requests.
CUSTOMER SERVICE AGENT
ADECCO
MELBOURNE, FL
09.2018 - 01.2019
- Recommend additional products and services based on customer needs and account details.
- Open customer accounts by recording information and updating account records.
- Maintain accurate customer records and process payments through each interaction.
CNA
WAVECREST HEALTH AND REHABILITATION
MELBOURNE, FL
07.2017 - 09.2018
- Administered physician-ordered treatments, including catheterizations, suppositories, irrigations, enemas, massages, and clean dressings.
- Responded to call signals, bells, and intercoms to assess patient needs and provide timely assistance.
- Monitored pulse, temperature, and respiration to track patient condition and escalate changes promptly.
- Maintained records of patient progress, services performed, and observations for supervisor and case manager review.
- Assisted with linens, laundry, cleaning, and personal care to keep patient spaces comfortable and orderly.
TIER 1 VIDEO REPAIR AGENT
SPECTRUM
MELBOURNE, FL
02.2017 - 06.2017
- Documented customer interactions, inquiries, complaints, and resolution steps to keep account records complete.
- Resolved service issues by confirming required account changes and following through until problems were corrected.
- Processed customer payments and applied them accurately to the appropriate accounts.
- Answered questions about schedules, accommodations, procedures, and policies with clear, customer-focused communication.
- Explained billing details to customers and revised inaccurate information when needed.
HEALTH SUPPORT TECH
FLORIDA DEPARTMENT OF HEALTH, BREVARD COUNTY
FL
08.2013 - 09.2015
- Maintained student care records and shared observations with supervisors and case managers to support ongoing care plans.
- Checked pulse, temperature, and respiration, then recorded changes and escalated concerns when readings fell outside normal ranges.
- Assisted patients transferring in and out of wheelchairs and vehicles, maintaining safe movement and comfort throughout care.
- Monitored diabetic students during insulin administration, administered medication, and supported basic first aid as needed.
- Navigated sensitive student health needs with discretion, following care instructions and maintaining HIPAA-compliant documentation.
Education
Diploma - undefined
AMERICAN SENIOR HIGH
HIALEAH, FLCNA /HHA CERTIFICATION - undefined
LAKE TECHNICAL INSTITUTION
EUSTIS, FLSkills
Patient scheduling coordination
Insurance benefit verification
Prior authorization support
Claims denial resolution
Patient assistance program processing
Member service call handling
Care coordination support
Timeline
Program Specialist II
Eversana
04.2022 - Current
Patient Service Representative
TalentBridge
11.2020 - 03.2022
Members Relations Representative
Firstsource Health Plans and HealthCare Services
08.2020 - 10.2020
CNA
AVANTE GROUP
05.2020 - 08.2020
CNA
BAY BREEZE SENIOR LIVING AND REHABILITATION CENTER
01.2020 - 04.2020
CUSTOMER SERVICE AGENT for Cigna Healthcare
MANPOWER STAFFING
01.2019 - 01.2019
CUSTOMER SERVICE AGENT
ADECCO
09.2018 - 01.2019
CNA
WAVECREST HEALTH AND REHABILITATION
07.2017 - 09.2018
TIER 1 VIDEO REPAIR AGENT
SPECTRUM
02.2017 - 06.2017
HEALTH SUPPORT TECH
FLORIDA DEPARTMENT OF HEALTH, BREVARD COUNTY
08.2013 - 09.2015
CNA /HHA CERTIFICATION - undefined
LAKE TECHNICAL INSTITUTION
Diploma - undefined
AMERICAN SENIOR HIGH