Lesley Calomeris
Minatare,NE
Summary
Organized and dependable candidate successful at managing multiple priorities with a positive attitude. Willingness to take on added responsibilities to meet team goals.
Overview
15
15
years of professional experience
1
1
Certification
Work History
Prior Authorization Specialist
Regional West Medical Center
Scottsbluff, NE
06.2024 - Current
- Collaborated with healthcare providers to gather necessary documentation for approvals.
- Reviewed patient records for accuracy and completeness, mitigating potential delays in care.
- Utilized electronic health record systems to track and manage authorization workflows.
- Processed prior authorization requests efficiently, ensuring compliance with insurance protocols.
- Educated staff on prior authorization procedures, enhancing understanding and adherence to guidelines.
Reimbursement Collection Specialist
Cochlear Americas
Centennial, CO
07.2016 - Current
- Duties: Managed patient accounts with outstanding balances, ensuring timely follow-up and resolution. Review account for insurance and billing accuracy. Work directly with contracted and non-contracted insurance carriers to obtain correct reimbursement. Using multiple resources ie: Insurance website, Billing Guide, phone calls, determine reason payment is outstanding. Reconcile the account by correcting any errors found. Adjusted account postings and reversals. Reviewed and reconciled rejected claims in Brightree, identifying efficient submission methods for prompt resolution with insurance. Documented all account changes and findings, maintaining accurate patient records for compliance and reference. Communicate with insurance companies regarding coding and billing concerns, payments and claims processing. Issue refunds. Assist authorization department in obtaining authorizations. Assist Customer Service with phone calls from recipients. Help to educate recipients on patient balances, patient responsibility as determined by insurance, Financial Hardship and setting up payment plans on balance due.
- Supervisor: Shonnie Dennis
- Phone: (303) 264-2209
HIMS Tech
Banner Health
Torrington, WY
12.2018 - 10.2020
- Entered all applicable documents in EMR, making daily rounds to obtain and verify accuracy of patient information and documentation type. Scanning of documents into the EMR, and completing the verification process to assure documents scanned correctly and routed to the correct patient's chart. Unsigned documents are forwarded to physician for review and/or signature. Reviewed, prepared, and scanned documents from Cardiac Rehab, Behavioral Health, and Respiratory Therapy to ensure accurate record-keeping. Released medical records upon request, facilitating timely access to patient information. I also maintain a log of surgeries and check quality control for documentation
- Reason for Leaving: Looking for a position that will allow me to grow within the company.
- Supervisor: Susan Guth-Schwendt
- Phone: 307-534-7138
Medical Claims Examiner
Regional Care Incorporated
Scottsbluff, NE
08.2023 - 06.2024
- Analyzed medical claims for accuracy and adherence to policy guidelines.
- Processed reimbursements efficiently, ensuring timely payments to providers.
- Collaborated with healthcare professionals to resolve claim discrepancies.
- Maintained updated knowledge of insurance regulations and compliance standards.
- Developed process improvements that enhanced claim resolution times and accuracy.
Practice Coordinator
Unique Prints Pediatric Therapy
Denver, CO
02.2015 - 07.2016
- Duties: Manage patient accounts, post daily charges and bill insurance. Enter daily charges into the billing system; submit electronic and manual claims to insurance. Post patient payments, EOB’s and reconcile patient accounts. I am also responsible for maintaining patients’ financial folder, collecting delinquent accounts, verifying insurance and patient benefits. I conduct financial intake appointments with parents to inform them of their benefits for the recommended treatment plan. Follow up on insurance denials, pending and unpaid insurance payments.
- Reason for leaving: I needed a position with more stability and with room for growth and advancement.
- Manager: Deb Murphy
- Phone: (303) 304-9604
Physician Services Representative
Centura Health
Englewood, CO
07.2013 - 02.2015
- Duties: Review patient accounts with outstanding balances for insurance and billing accuracy. Work directly with contracted insurance carriers to obtain correct reimbursement. Using multiple resources ie: Insurance website, DMS, MedAssets, Cactus, LSS, determine reason payment is outstanding. Reconcile the account by correcting any errors found. Post and/or reverse adjustments as needed. Review claims that are being rejected in the EBS, Research and reconcile the claim. Document all changes made to the account and all findings on patient account. Communicate with insurance companies regarding provider credentialing, coding and billing concerns, payments and claims processing. Promoted to Contract Compliance. Resolved concerns regarding coding and modifier issues and with how providers are credentialed with the insurance. Participated in weekly meeting with provider relations to discuss issues and work on resolution.
- Revenue Management/Physician services
- Reason for Leaving: Personal
- Manager: Kelly Morgan
- Phone: (303) 643-1190
- Contract Compliance
Financial Counselor
Centura Health
Littleton, CO
04.2011 - 07.2013
- Duties: I was shared between 3 practices to obtain surgical cost estimates for patients. I also advised patients of their insurance benefits, and helped them get a better understanding of how their insurance plan was structured. Worked directly with the providers to identify patients in need of financial assistance. Worked with uninsured patients to find resources to help cover their medical expenses. Center for Orthopedics: I monitored patient’s accounts following surgery for payment/billing concerns, reviewed 1500 claim forms for billing/coding errors. I was also responsible for monitoring the Workmen’s Compensation accounts to make sure that all information was obtained and correct for billing. I assisted the Office Manager with credentialing and billing/insurance issues. I also worked front and back office as needed.
- Center for Orthopedics
- Reason for leaving: Position was terminated.
- Manager: Jan Pinder
Education
Medical Assistant -
Colorado College of Medical and Dental Careers
Denver, CO01-1980
Certified Massage Therapist - undefined
Colorado School of Healing Arts
Lakewood, CO01-2004
AA - undefined
Community College of Aurora
Aurora, CO01-1995
Skills
- Works Well Under Pressure
- Problem-solving
- Multitasking and organization
- Detail oriented
- Documentation and reporting
- Critical thinking
- Verbal and written communication
- Work Planning and Prioritization
- Customer interaction
- Deadline oriented
- Relationship building
- Extensive organizational skills
- Issue resolution
Accomplishments
- Used Microsoft Excel to develop Surgery authorization tracking spreadsheet.
- Collaborated with team of 6 in the resolution of a sister facility not being recognized by third party vendor of insurance company. Was able to help implement a work around in order to obtain Radiation Oncology authorizations until new credentialing could be implemented..
Certification
Certified Medical Assistant
Certified Massage Tharapist
RCI-Employee of the Quarter after my first 3months of employment
I was given this award the end of my first quarter of my employment for my role in establishing a positive relationship with our vendor by creating a more fluid process for claims reconciliation.
Timeline
Prior Authorization Specialist
Regional West Medical Center
06.2024 - Current
Medical Claims Examiner
Regional Care Incorporated
08.2023 - 06.2024
HIMS Tech
Banner Health
12.2018 - 10.2020
Reimbursement Collection Specialist
Cochlear Americas
07.2016 - Current
Practice Coordinator
Unique Prints Pediatric Therapy
02.2015 - 07.2016
Physician Services Representative
Centura Health
07.2013 - 02.2015
Financial Counselor
Centura Health
04.2011 - 07.2013
Certified Massage Therapist - undefined
Colorado School of Healing Arts
AA - undefined
Community College of Aurora
Medical Assistant -
Colorado College of Medical and Dental Careers