LindsayAnne Lindsay
Wilsonville,OR
Summary
Dynamic Senior Claims Reprocessor with expertise in cross-department collaboration and mentorship. Committed to driving operational efficiency and enhancing quality standards, while fostering a culture of teamwork and continuous improvement.
Overview
26
26
years of professional experience
1
1
Certification
Work History
Senior Claims Reprocessor
Providence Health Plan
Beaverton, OR
08.2022 - Current
- Claims reprocessing via Member/Provider calls, Provider Representative reprocessing requests and reprocessing requests from System Admin/Configuration updates.
- Strong focus on recognition for quality improvement including identifying Facets errors/issues and trends with claims team processor errors. Working with both claims team supervisors for quality improvement process and system admin teams for configuration updates. Identifying areas of improvement for provider satisfaction and provider representative ability to educate providers of claim processes.
- Maintaining exceeds exceptions for both quality and quantity of claims work assigned, and willing to help others in expediting claims work for provider/member satisfaction.
- Graduated Mission Leadership Academy 2024 with ongoing education provided.
- Mission Integration subcommittee co-chair 2020-2024, current Mission Integration subcommittee member.
- Working closely with multiple departments and team leads have established myself and my work as dependable and Mission driven. Daily goal of easing others way.
- Versatile professional with strong problem-solving skills and history of adapting to diverse challenges. Applies innovative solutions and technical expertise to deliver exceptional results. Committed to streamlining processes and advancing organizational objectives.
Training, Quality and Compliance
Providence Health Plan
Beaverton, OR
09.2021 - 08.2022
- Training and auditing new hire classes, coordinated with other TQAC'S for multiple claims process, Commercial, ASO and Individual lines of business focus.
- Assisted with day-to-day operations, working efficiently and productively with all team members.
- Worked flexible hours across night, weekend, and holiday shifts.
- Used critical thinking to break down problems, evaluate solutions, and make decisions.
- Developed and maintained courteous and effective working relationships.
- Identified issues, analyzed information, and provided solutions to problems.
- Resolved problems, improved operations, and provided exceptional service.
- Provided professional services and support in a dynamic work environment.
Commercial Claims Adjuster
Providence Health Plan
Beaverton, OR
06.2013 - 09.2021
- Evaluated complex commercial claims to determine liability and coverage under policy provisions.
- Collaborated with healthcare providers to gather necessary documentation for claim processing.
- Analyzed claims data to identify trends and recommend process improvements.
- Mentored junior adjusters on best practices for claims assessment and decision-making.
- Streamlined workflows, reducing claim processing time while ensuring compliance with regulations.
- Ensured compliance with state regulations and internal guidelines while managing claim files from inception through closure.
- Evaluated potential fraud indicators within claim files, contributing to the identification and prevention of fraudulent activity.
- Improved claim resolution times by efficiently investigating and evaluating commercial insurance claims.
- Served as a mentor for junior adjusters by providing guidance on claim handling techniques, company procedures, and industry best practices.
- Contributed to team meetings and training sessions by sharing best practices, lessons learned, or case studies relevant to the commercial claims adjusting process.
Customer Service Representative
Providence Health Plan
Beaverton, OR
09.2012 - 06.2013
- Resolved customer inquiries through effective communication and problem-solving techniques.
- Educated members on health plan benefits and services to enhance understanding and engagement.
- Collaborated with cross-functional teams to streamline processes and improve service delivery.
- Mentored junior representatives, fostering a culture of knowledge sharing and support among staff.
- Managed escalated cases, utilizing conflict resolution skills to achieve favorable outcomes for customers.
- Managed high-stress situations effectively, maintaining professionalism under pressure while resolving disputes or conflicts.
- Resolved customer complaints with empathy, resulting in increased loyalty and repeat business.
- Handled escalated calls efficiently, finding satisfactory resolutions for both customers and the company alike.
- Responded to customer requests for products, services, and company information.
- Developed strong product knowledge to provide informed recommendations based on individual customer needs.
- Developed rapport with customers through active listening skills, leading to higher retention rates and positive feedback from clients.
- Assisted customers in navigating company website and placing online orders, improving overall user experience.
- Exceeded performance metrics consistently, earning recognition as a top performer within the team.
Surgery Scheduling Coordinator
Retina Northwest
Portland, OR
01.2010 - 08.2012
- Coordinated patient scheduling for surgical services, optimizing daily appointment flow.
- Collaborated with clinical staff to ensure accurate patient information and compliance with protocols.
- Managed pre-operative documentation, facilitating efficient communication between departments.
- Implemented process improvements to reduce scheduling conflicts and enhance patient experience.
- Oversaw data management systems to maintain accurate records of surgeries and follow-up appointments.
- Managed high volume of incoming calls and inquiries related to surgery scheduling with professionalism and attention to detail.
- Coordinated pre-surgical testing requirements to minimize delays or cancellations on the day of surgery.
- Coordinated complex surgical cases, including multi-disciplinary surgeries, to optimize patient outcomes.
- Maintained confidentiality and compliance with HIPAA regulations while handling sensitive patient information and documentation.
CNA/Surgery Technician
Legacy Meridian Park Medical Center
Tualatin, OR
06.2007 - 09.2009
- Provided direct patient care, assisting with daily living activities and ensuring comfort.
- Monitored vital signs and reported significant changes to nursing staff for timely interventions.
- Maintained accurate patient records, documenting care provided and observations efficiently.
- Assisted in implementing care plans tailored to individual patient needs and preferences.
- Collaborated with interdisciplinary teams to enhance patient outcomes through coordinated care efforts.
- Led initiatives to improve workflow efficiency within the nursing unit, enhancing overall team performance.
- Advocated for patients' rights and needs, fostering a compassionate environment conducive to healing.
- Maintained confidentiality of patient information according to HIPAA guidelines while communicating effectively with team members about critical updates.
CNA/Unit Secretary
Providence St. Vincent Medical Center
Portland, OR
06.2000 - 06.2007
- Assisted patients with daily living activities to enhance comfort and independence.
- Monitored vital signs and reported changes to nursing staff for timely interventions.
- Maintained accurate patient records in compliance with healthcare regulations and standards.
- Collaborated with multidisciplinary teams to deliver comprehensive patient care plans.
- Implemented workflow improvements that increased efficiency in care delivery processes.
- Advocated for patient needs, ensuring a supportive and responsive healthcare environment.
- Enhanced patient satisfaction by providing compassionate and attentive care.
Education
Certificate of Leadership - Mission Leadership
Mission Leadership Academy
Providence Health & Services02-2024
Oregon State Board of Nursing Assistant - Certified Nursing Assistant Level 2
Portland Community College
Portland, Oregon, OR08-2000
No Degree - Certified Beauty Consultant
Beaverton School of Beauty
Beaverton07-1996
High School Diploma -
Westside Christian High School
Lake Oswego, Oregon09-1995
Skills
- Friendly, positive attitude
- Teamwork and collaboration
- Customer service
- Problem-solving
- Attention to detail
- Flexible and adaptable
- Dependable and responsible
- Multitasking
- Excellent communication
- Critical thinking
- Organizational skills
- Decision-making
- Problem resolution
Certification
Mission Leadership Academy graduate Class 2024
Timeline
Senior Claims Reprocessor
Providence Health Plan
08.2022 - Current
Training, Quality and Compliance
Providence Health Plan
09.2021 - 08.2022
Commercial Claims Adjuster
Providence Health Plan
06.2013 - 09.2021
Customer Service Representative
Providence Health Plan
09.2012 - 06.2013
Surgery Scheduling Coordinator
Retina Northwest
01.2010 - 08.2012
CNA/Surgery Technician
Legacy Meridian Park Medical Center
06.2007 - 09.2009
CNA/Unit Secretary
Providence St. Vincent Medical Center
06.2000 - 06.2007
Certificate of Leadership - Mission Leadership
Mission Leadership Academy
Oregon State Board of Nursing Assistant - Certified Nursing Assistant Level 2
Portland Community College
No Degree - Certified Beauty Consultant
Beaverton School of Beauty
High School Diploma -
Westside Christian High School