Summary
Overview
Work History
Education
Skills
Timeline
Generic

Kanesha Lyons

Grand Rapids,MI

Summary

EPIC, Healthquest, Kronos, Chartmaxx, ISSAC, Powerchart, Avality, Facet, Onbase,Verint, Salesforce, eThomas, Geneseys, Cerner ICD 9, ICD 10, CPT, HCPCS Microsoft Teams,Word, Excel, Powerpoint, Outlook Customer Service/Sales SME/Trainer Medical Billing/Collections Data Entry Prior Authorizations CISCO

Overview

7
7
years of professional experience

Work History

Medicare HEDIS Data Entry Representative (Subject Matter Expert)

Aetna/CVS
Wyoming, USA
07.2022 - Current
  • Collect effective data elements in the CRM tool to support medical record chasing for HEDIS medical record documentation and services.
  • Assists in the training and education of HEDIS Outreach Representatives, new systems, processes, HEDIS Measures and resolution to member barriers.
  • Outreach to members who don't have a record of the designated services, effective capture of barriers and data collection, use of motivational interviewing skills to provide solutions in order to close the gap in care, and providing best in class support to each member.
  • Initiates outbound calls to members and providers to collect information and provide care coordination assistance in obtaining services (e.g. schedule appointments, provider appointment reminders, coordinate transportation, etc.).
  • Maintains CRM tool to track member history and compliance.
  • Documents member history and participation in outreach activities in the CRM tool.

Authorization Specialist

Cigna Healthcare/EviCore
Wyoming, USA
04.2020 - 07.2022
  • Performing insurance benefit investigation.
  • Counseling patients/providers on their insurance coverage.
  • Input patient/provider data into the electronic medical record system.
  • Assist with approvals and denials using knowledge of medical terminology and ICD coding, questions regarding insurance coverage, copayments, deductibles, prior authorizations, benefits, in network providers, and claims.
  • Keep patients and providers up to date on process.

Uro Patient Financial Service Representative

Trinity Health/Mercy Health
Kentwood, USA
11.2017 - 02.2020
  • Documents customer complaints, issues, and interactions in appropriate system(s).
  • Assists in the training and education of Customer Service Representative I colleagues upon hire and ongoing, and as new systems, processes or payers are created.
  • Proactively follow up on delayed payments by contacting patients and third-party payers and determining the cause for delay and supplying additional data as required.
  • Assists patients to resolve billing issues, handles complaints, and sets up payment plans.
  • Documents timely and accurately all encounters with members on their account.
  • Inform members of insurance and governmental programs, regulations and billing processes.
  • Researches accounts to provide correct balance and payment options.
  • Collect on patients delinquent account balances.

Education

Medical Insurance Billing & Coding - Office Administration

Ross Medical
Kentwood, Michigan
02.2016

Skills

  • EPIC
  • Healthquest
  • Kronos
  • Chartmaxx
  • ISSAC
  • Powerchart
  • Avality
  • Facet
  • Onbase
  • Verint
  • Salesforce
  • EThomas
  • Geneseys
  • Cerner
  • ICD 9
  • ICD 10
  • CPT
  • HCPCS
  • Microsoft Teams
  • Word
  • Excel
  • Powerpoint
  • Outlook
  • Customer Service/Sales
  • SME/Trainer
  • Medical Billing/Collections
  • Data Entry
  • Prior Authorizations
  • CISCO

Timeline

Medicare HEDIS Data Entry Representative (Subject Matter Expert)

Aetna/CVS
07.2022 - Current

Authorization Specialist

Cigna Healthcare/EviCore
04.2020 - 07.2022

Uro Patient Financial Service Representative

Trinity Health/Mercy Health
11.2017 - 02.2020

Medical Insurance Billing & Coding - Office Administration

Ross Medical

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Kanesha Lyons