LICHELLE WRIGHT
Davenport,FL
Summary
Dedicated professional with over 5 years of experience working in leadership roles within a medical office setting. Excellent ability to investigate appeals and grievance, review and process insurance claims. Proven record of effectively communicating with providers, insurance representatives, vendors and patients while adhering to HIPAA and patient confidentiality requirements. Applies solid analysis and risk management skills to devise and implement solutions that increase efficiency, streamline operations and decrease overall expenses with minimal resources. Develops lasting impression resulting in strong stakeholder relationships and profit expectations. Encouraging manager and analytical problem-solver with talents for team building, leading and motivating, as well as excellent customer relations aptitude and relationship-building skills. Proficient in using independent decision-making skills and sound judgment to positively impact company success. Dedicated to applying training, monitoring and morale-building abilities to enhance employee engagement and boost performance.
Overview
20
20
years of professional experience
Work History
Appeals and Grievances Team Lead
HealthFirst
01.2020 - Current
- Responsible for evaluating operations and identifying process improvements needs
- Identify irregular trends with grievances and appeals; work with other areas as appropriate to identify root causes and appropriate steps for resolution
- Manages member complaints, grievances and appeals that are presented by the member or provider pertaining to the authorization of or delivery of clinical and non-clinical services
- Manages a team of specialists, with responsibility for goal and productivity management, coaching and counseling, performance management and other leadership responsibilities as assigned
- Ensures Non-Clinical Staff expedite timely requests for information or case acknowledgement letters to meet compliance and productivity goals
- Understands HF’s internal health plans policies and procedures to frame decisions and interpret regulations and policies and makes critical decisions in support of the business
- Monitor Medicaid and Commercial processes to ensure that all regulatory requirements are followed
- Conduct audits and provide feedback to all areas that submit appeals and grievance
- Evaluated employee skills and knowledge regularly, training, and mentoring individuals with lagging skills.
- Worked with team to identify areas of improvement and devised solutions based on findings.
- Mentored and guided employees to foster proper completion of assigned duties.
- Developed and updated tracking spreadsheets for process monitoring and reporting.
Revenue Cycle Assistant Manager
Orlando Health Corporate
01.2019 - 01.2020
- Manage a team of twenty (20) team members: Thirteen (13) Medicaid A/R specialist, six (6) Commercial A/R
- Specialist and one (1) Business Analyst
- Oversee A/R for nine (9) facilities: South Lake ER – Blue Cedar
- Clermont and Four Corners, Orlando Health Regional Medical Center, Orlando Health Arnold Palmer
- Orlando Health Dr
- Phillips, Orlando Health South Seminole, Orlando Health Central Hospital and Orlando
- Health Winnie Palmer
- Manage escalated AR issues, communicating with patients, providers and coworkers in a timely, effective manner to expedite the billing and collections of accounts
- Collaborated with the Revenue Management Leadership team to develop and monitor goals for the Patient
- Accounts Departments and strategize on future key performance indicators
- Ensure team is contributing to the increase of monthly gross collections and increasing percentage of collections on accounts over 90 days past due
- Supervision improved productivity and decreased backlog
- Contributes to the steady reduction of denials by addressing complex denials timely, as well as identifying root causes and process improvement to prevent future denials or lack of consistency throughout the department.
- Established team priorities, maintained schedules and monitored performance.
- Made hiring recommendations to increase company's productivity and profitability with quality workers.
- Defined clear targets and objectives and communicated to other team members.
- Recruited, interviewed and hired employees and implemented mentoring program to promote positive feedback and engagement.
Revenue Cycle Assistant Manager
Orlando Health South Lake Hospital
01.2018 - 01.2019
- Manage a team of thirty-nine (39) team members: thirty-four (34) Patient Access Representatives and five (5)
- Telecommunication Representatives
- Oversee Patient Access for three (3) facilities: South Lake ER – Blue
- Cedar, Clermont and Four Corners
- Provided team development and coaching while maintaining reviews, adequate scheduling, QA on registrations for all areas, maintain QA statistics, reporting and conduct monthly staff meetings
- Ensure proper utilization of software/database including: Emdeon, Sunrise, Affinity, Availity and One Source
- Contributes to the A/R goal for patient registration
- Effectively manager and directs all area of registration to ensure quality, productivity and customer service.
- Opened and closed location and monitored shift changes to uphold successful operations strategies and maximize business success.
- Maintained positive customer relations by addressing problems head-on and implementing successful corrective actions.
- Monitored cash intake and deposit records, increasing accuracy, and reducing discrepancies.
Appeals & Grievances Team Lead
Center Light Healthcare
01.2015 - 01.2018
- Presented the Plan’s position at Fair Hearings including the examination of the enrollee, provided testimony and answering questions of counsel, appellant and hearing officer as well as summarizing the Plan’s case
- Responded to requests from the NYS External Appeals Agents, Empire State Medical Scientific and Educational
- Foundation, Federal Independent Review Entity (Maximus) for information in accordance with relevant regulation
- Monitor daily performance of staff related to timelines of acknowledgement and resolution of appeals.
Sr. Appeals & Grievance Specialist
Emblem Health
01.2013 - 01.2015
- Responsible for receiving, investigating and responding to appeals and complaints and grievances initiated by members and providers within contractual required time frames
- Responsible for compliance with regulatory and department timelines, prepared cases for external review, prepared and presented cases to the Internal Appeal Committees
- Received and prioritized a heavy volume of incoming communication including emails, faxes and phone calls
- Maintained accurate, up-to date confidential patient files
- Ensured data accuracy accountability for financial performance, charging methodologies, and revenue enhancements
Patient Access Supervisor
Northwell Health System
01.2007 - 01.2011
- Ensured accurate patient demographic and financial information were obtained during the intake process
- Oriented and trained new staff in all registration and billing procedures
- Assisted with insurance eligibility verification and advised non-insured patients of insurance enrollment and sliding scale fees
- Audited all patient accounts for accuracy and verified medical necessity for procedures performed
- Established a comprehensive training manual and quick reference guide for the patient access department.
- Received patient deductibles and co-pay amounts and discussed options to satisfy remainder of patient financial obligations.
Sales Account Executive
FedEx Express
06.2005 - 10.2007
- Leveraged CRM to collect, organize and manage sales data and customer information.
- Attended networking events to build relationships and identify sales opportunities.
- Negotiated sales deals between customers and agency, resulting in mutually beneficial agreements and cultivated relationships.
- Managed sales cycle to maintain solid customer base.
- Mastered and constantly improved sales prospecting, follow-up and upsell processes.
- Trained, coached, and mentored new sales associates for maximum performance.
- Participated in store meetings and product training sessions to understand and sell items.
- Assisted in development of monthly sales goals to motivate team and drive business objectives.
- Monitored service after sale and implemented quick and effective problem resolutions.
Lead Retail Sales Consultant
AT&T Mobility
05.2004 - 04.2005
- Offered hands-on assistance to customers, assessing needs, and maintaining current knowledge of consumer preferences.
- Oversaw employee performance, corrected problems, and increased efficiency to maintain productivity targets.
- Exceeded sales goals and accomplished business objectives by inspiring staff and promoting target products.
- Coached sales associates in product specifications, sales incentives, and selling techniques, significantly increasing customer satisfaction ratings.
- Supported executive and marketing departments in promotional asset development, material deadlines and product approvals.
Education
Master of Science - Business Administration
Brooklyn College
Brooklyn, NY2016
Bachelor of Science - Business Administration
Medgar Evers College
Brooklyn, NY2012
Skills
- CRITICAL COMPETENCIES
- Medical Terminology
- HIPAA Rules
- Analytical Skills
- Risk Assessment
- Account Management
- Revenue Cycle Management
- Medicaid & Medicare
- Insurance Claims
- Appeals & Grievance
- Multi-Tasking Abilities
- Quality Assurance
- Critical Thinking
- Research Abilities
- Database Entry & Management
- MS Word, Excel & Outlook
- Medical Records
- Denial Management
- Case Management
- Sales expertise
- Cross-selling techniques
- Product and Service Sales
- Persuasive Selling
- Sales Team Leadership
- Business Development and Planning
Timeline
Appeals and Grievances Team Lead
HealthFirst
01.2020 - Current
Revenue Cycle Assistant Manager
Orlando Health Corporate
01.2019 - 01.2020
Revenue Cycle Assistant Manager
Orlando Health South Lake Hospital
01.2018 - 01.2019
Appeals & Grievances Team Lead
Center Light Healthcare
01.2015 - 01.2018
Sr. Appeals & Grievance Specialist
Emblem Health
01.2013 - 01.2015
Patient Access Supervisor
Northwell Health System
01.2007 - 01.2011
Sales Account Executive
FedEx Express
06.2005 - 10.2007
Lead Retail Sales Consultant
AT&T Mobility
05.2004 - 04.2005
Master of Science - Business Administration
Brooklyn College
Bachelor of Science - Business Administration
Medgar Evers College
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