Janay Lewis
Houston,TX
Summary
My name is Janay Lewis, and I am pursuing a major in legal studies at Houston Community College, where I am working towards my AA degree.
Moreover, I am particularly interested in various aspects of the legal and medical fields, taking pride in my professional demeanor and recognizing myself as a well-rounded individual. I am poised to excel in roles such as intake specialist, patient account coordinator, claims specialist, and collections specialist.
Additionally, I seek a position that offers opportunities for advancement, financial stability, and a collegial environment. I am a highly skilled and experienced Senior Appeals and Grievances Specialist with a demonstrated history of effectively managing and resolving grievances and inquiries under Medicare Advantage Part C and D, as well as handling executive-level complaints and appeals related to Medicare Advantage and Pharmacy Benefit Management plans.
Essentially, I am eager to expand my knowledge and engage with individuals from diverse backgrounds to develop innovative strategies for fostering a positive workplace and delivering outstanding customer service to clients and members. Furthermore, my dedication to exceeding customer expectations enables me to cultivate rapport, a skill honed through experience rather than instruction.
Therefore, thank you for the opportunity.
Overview
10
10
years of professional experience
Work History
Intake Specialist | Case Manager
Godsey Martin Law Firm
Houston, TX
01.2021 - Current
- Organizing and completing necessary documentation
- Monitoring case statuses, and answering client questions
- Client referals to the attorney if necessary, and scheduling court cases, hearings and attorney client meetings, meditation, depositions, and assisting with billing, and claims for negotiation
- Preparing LOP, LOR, and POA documents for medical referals for urgent chiropractic services, theraputic services, and additional services
- Organize and maintain case files, help manage caseload requirements, and monitor budgets, timelines, and billing for case completion
- Introduced PC's/ PNC's to firm provided information and knowledge to client in reference to the services offered by the firm
- Signed as many as 4 -6 cases daily, monthly goal about 45- 50 case monthly
- High conversion rate of 85% with assisting clients with signing FA
- Assisting clients with scheduling medical appointments, using CPT codes and primary, and secondary billing of insurance
- Customer referral using LOP, And NOR documents to said PCP, or Physician
Medical Member Service Specialist | CM
Molina Health Care
Houston, TX
12.2019 - 01.2021
- Maintained accurate records of all transactions according to established procedures
- Explained various types of accounts available to customers in order to meet their individual needs
- Generated reports on membership activity for senior management review
- Monitored trends in customer feedback in order to identify areas needing improvement within the organization
- Reviewed patient records to ensure accuracy of information and completeness of documentation for Medicare claims processing
- Maintained current knowledge of Medicare and Medicaid regulations related to billing practices
- Maintained compliance with federal regulations such as HIPAA, OSHA and Medicare and Medicaid
- Maintained detailed records of member interactions and transactions to track issues, trends, and opportunities for improvement in service delivery responding to inquiries, requests, and complaints addressed by customer and members pertaining to their enrollment with Medicaid and Medicare of NE, and WI, CA
Billing Coordinator Specialist | AP/AR
Getix Medical Health LLC
Sugar Land, TX
02.2016 - 11.2019
- Preapproved information about eligibility requirements, application details, payment methods and applicants' legal rights during intake, based on POA status for Disbility or Atty rep
- Data entry, and clerical assistance in billing department
- Progress reporting
- Resource information
- Documentation and paperwork
- Case management
- Cash handling and management
- Claims analysis
- Insurance coverage verification
- Offered compassionate and attentive guidance to patients during moments of crisis and trauma
- Interacted kindly with insurance providers via phone, email and written correspondence to obtain necessary documents to complete registration
- Answered phone calls and provided new clients with required paperwork to initiate service
Intake Specialist | Case Manager
Guss and Associates LLC
Downtown, TX
12.2014 - 05.2017
- Conducted initial intake interview to obtain client information, including biographical data, medical history, presenting problem, legal status, and other pertinent information
- Provided crisis intervention services as needed to clients in distress
- Documented all patient contact activities in accordance with agency standards and regulations
- Monitored progress of clients throughout the course of treatment and adjusted treatment plans accordingly
- Scheduled appointments for clients as needed for outside services such as counseling or medical care
- Ensured that all necessary paperwork was completed accurately before discharge from program
- All legal Correspondence fax, email, phone
- Additionally I remained proactive with case management services, maintaining client treatment plans and providing feedback and required updates to patients
- I provided powerful recommendations and resources to current clients pertaining to PHI release, and HIPPA medical authorization of record retrievals
- NOR / LOP MEDICAL TRTMNT 1ST AND 3P DEFENDANT
- Maintained patient charts using various software systems like: Case Peer, Sales force, Nolo, Excel, and Adobe platform for combining and separating legal and medical documents
- Assisted with incoming new prospective clients and current clients set clear expectations with clients on the details of their cases, and manage new client
- Assisted with patient onboarding and data entry, help lawyers book and manage their appointments virtual or in- person
- Scheduled office meetings and client appointments for the team and ensured attorney appointments scheduled accordingly for mediations, and depositions
Education
Associate of Arts - Criminal Law | Political Science
Houston Community College
Houston, TX06.2025
High School Diploma -
Daniel Pearl Magnet High School
Los Angeles, CA07-2017
Skills
- Critical Thinking
- Exceptional organizational and time management capabilities, with a keen focus on detail and accuracy in data entry
- Proficient in both written and verbal communication
- Comprehensive understanding of medical terminology and quality assurance within a managed care framework
- In-depth knowledge and investigative expertise related to Fraud, Waste, and Abuse (FWA)
- Experienced in utilizing a variety of computer applications
- Strong command of ICD-10-CM, CPT, and HCPCS coding guidelines
- Skilled in industry-specific claims and Health Information System software, including EPIC, Cerner, AllScript, OnBase, FACETS, NICE, COSMOS, and Salesforce
- Capable of identifying and addressing moderate issues with minimal supervision
- Robust analytical, resolution, and problem-solving abilities
- Competent in adhering to established procedures, policies, and State/Federal regulations (CMS, NCQA, OIG, HHS, NAIC, HEDIS, ERISA, IDR)
- Solid understanding of the Explanation of Benefits (EOB), Electronic Remittance Advice (ERA), Coordination of Benefits (COB), Managed Care Contracts, Contract Language, as well as relevant Federal and State Regulations
- Proficient in Microsoft Office applications, including Excel, Outlook, Word, Access, SharePoint, and Power BI
Languages
- Spanish ~ Intermediate, not fluent.
- Persian ~ Beginners
Timeline
Intake Specialist | Case Manager
Godsey Martin Law Firm
01.2021 - Current
Medical Member Service Specialist | CM
Molina Health Care
12.2019 - 01.2021
Billing Coordinator Specialist | AP/AR
Getix Medical Health LLC
02.2016 - 11.2019
Intake Specialist | Case Manager
Guss and Associates LLC
12.2014 - 05.2017
Associate of Arts - Criminal Law | Political Science
Houston Community College
High School Diploma -
Daniel Pearl Magnet High School