Elaine Lee
Summary
Adept at healthcare administration and insurance expertise, I significantly enhanced performance and workflows for multiple physicians. Leveraging strong contract administration and interpersonal skills, I streamlined workflows, negotiated beneficial contracts, and implemented cost-saving strategies, contributing to substantial organizational improvements.
Overview
6
6
years of professional experience
Work History
Managed Care Coordinator
Adventist Health Castle Medical Center
07.2021 - Current
- Developed strong working relationships with physicians to streamline workflows and improve performance.
- Optimized resource allocation within the organization by analyzing utilization data and identifying opportunities for shared savings and lowering overall cost of care.
- Implemented evidence-based strategies for reducing emergency department visits among high-utilization patients through proactive outreach initiatives.
- Negotiated contracts on behalf of physicians with insurance companies that allow for more efficient use of resources and opportunities for performance incentives and quality improvement.
- Coordinated interdisciplinary team meetings to optimize performance and ensure effective communication among providers.
- Streamlined the managed care process for better efficiency through thorough documentation and accurate recordkeeping.
- Ensured compliance with regulatory standards by staying current on industry best practices and incorporating them into daily operations.
- Collaborated with healthcare providers to identify gaps in care, devising targeted interventions for performance and quality improvement.
- Contributed significantly towards organizational goals by constantly seeking opportunities to improve processes and outcomes.
- Established and maintained effective communication with staff, physicians and community organizations to promote high quality patient care.
- Responsible for managing 6000 plus attributed lives in all lines of business (quest, medicare, commercial) and performance management for 8 different primary care providers working in a capacitated reimbursement model.
Eligibility Senior Representative
Accredo Specialty Pharmacy
11.2020 - 07.2021
- Streamlined prior authorization review process for faster turnaround times and higher approval rates.
- Optimized workload distribution among team members to maximize productivity without compromising service quality levels.
- Increased customer satisfaction, providing timely and thorough responses to all inquiries received through various channels.
- Demonstrated commitment to data privacy by adhering strictly to security protocols when handling confidential applicant information.
- Elevated team performance through active contributions during meetings, offering insightful suggestions based on past experiences and industry research findings.
- Boosted overall efficiency by developing comprehensive resources that streamlined workflows and improved internal communication processes.
- Assisted management in identifying areas of improvement within the department through detailed analysis and reporting of trends.
- Expedited resolution of escalated cases, liaising patients, physicians and insurance companies to resolve discrepancies or clarify information.
Benefit Verification Representative
CVS Specialty Pharmacy
02.2019 - 11.2020
- Provided exceptional customer service by addressing patient concerns regarding coverage and out-of-pocket expenses.
- Managed high-volume caseloads while maintaining strict deadlines for completing benefit verifications and authorizations.
- Ensured compliance with HIPAA regulations during all aspects of the benefit verification process, protecting patient privacy.
- Improved patient satisfaction by accurately verifying benefits and providing timely responses to inquiries.
- Expedited claim approvals by promptly submitting necessary documentation to insurance providers.
- Reduced claim denials with thorough insurance eligibility assessments prior to service provision.
- Leveraged advanced problem-solving skills in navigating complex cases involving multiple policies or payers, ultimately securing coverage approvals where possible.
Education
Bachelor of Science - Biological Sciences
University of California Santa Barbara
Santa Barbara, CASkills
- Insurance expertise
- Healthcare administration
- Contract administration
- Performance Management
- Performance tracking
- Performance improvement
Timeline
Managed Care Coordinator
Adventist Health Castle Medical Center
07.2021 - Current
Eligibility Senior Representative
Accredo Specialty Pharmacy
11.2020 - 07.2021
Benefit Verification Representative
CVS Specialty Pharmacy
02.2019 - 11.2020
Bachelor of Science - Biological Sciences
University of California Santa Barbara
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