Lisa A. Williams
Charlotte,NC
Summary
Emotionally intelligent subject matter expert with over 10 years of experience in remote team leadership and healthcare operations, including de-escalation. I am proficient in Microsoft Office, Google Suite and EHR/EMR systems, with a proven track record of delivering accurate and timely results. Recognized for exceptional leadership and collaboration with internal and external stakeholders and awarded the Star Award for enhancing team efficiency and knowledge sharing.
Overview
26
26
years of professional experience
Work History
Care Specialist, Provider Escalations
Oscar Health Inc
05.2025 - Current
- Use workflows to handle complex issues from healthcare providers via chat and softphone escalation.
- Mediator between both internal and external groups in investigating issues with claims, contracts, fee schedules and processing to resolution.
- Liaison between interdepartmental within organization while being point of contact for Care Guides and providers.
- Document and maintain comprehensive notation when using a ticketing system, taking steps to communicate and resolve timely.
- Provides training to customer service reps and peers in processes and procedures to identify trends to reduce future escalations.
- Monthly collaboration with management to identify opportunities for improvement for the de-escalation processes.
- Compliant with all policy, procedures according to laws and regulations.
Authorization Coordinator, Utilization Management
Piedmont Medical Center
Rock Hill, SC
08.2023 - 04.2025
- Provided expert support to providers and third-party payors to secure diagnosis-specific authorizations, preventing escalations to the Medical Director.
- Navigate multiple specialties via systems to cross-reference provider types for procedures, ensuring attention to detail.
- Maintain weekly metrics of 98%+ in authorization retrieval and denial management for a 442-bed facility.
- Escalated via telephone, chat, and secure messages to various departments to resolve issues while upholding HIPAA compliance.
- Process authorization approvals, denials and forward appeals to designated department for review.
- Serve as a liaison with TPA insurance companies and Physician Advisors for commercial, private and government denial reconsideration peer reviews.
- Provided effective leadership through training and mentorship to new hires and staff, ensuring compliance, best practice and performance management.
- Proactively identified root cause of complex operational processes to resolution.
Production Lead/MRA Retrieval Specialist (Remote)
Humana Inc.
Charlotte, NC
09.2012 - 02.2016
- Managed, coached and supported day-to-day operations of direct reports in developing and maintaining operation workflow for HEDIS Medical Record Reviews to assess patient medical risk needs.
- Managed and partnered with providers with scheduling onsite appointments to retrieve and review electronic health records including all PHI from EMR databases, adhering to NCQA Standards, CMS, and HIPAA regulations.
- Demonstrated effective communication with team to set individual goals and encouraged through the process.
- Reviewed documentation for audit and verification, identifying inaccuracies or potential fraud.
- Trained new and existing staff on practices and procedures, serving as a resource across departments.
Benefit Verification Specialist
AmerisourceBergen
Charlotte, NC
09.2010 - 03.2012
- Answered and initiated member, provider, and pharmacy calls to verify prior authorizations, insurance coverage, and eligibility for billing and collections of prescription plans.
- Identified root causes of issues, implementing resolutions tracked through the departmental intranet.
- Collaborated with peers, providers, third-party services, pharmacy representatives, and stakeholders to ensure accurate processing amid business changes.
Provider Network Coordinator (Remote), Supervisor (Hybrid), Sr. Managed Care Claims Coordinator, Claims A/R Payment Adjuster
Independence Blue Cross
Philadelphia, PA
02.2000 - 07.2009
- Advocated for in-network and out-of-network providers, stakeholders and team members to resolve TPA high complex claims payment issues.
- Conducted root cause analysis for claim adjustments, educating team members and providers on industry standards and system protocols.
- Audited provider files and claims payments, coordinating special projects through investigation of trends resulting in accurate adjudication.
- Managed and coordinated with a team of 22 direct reports to ensure standards, compliance and quality metrics have been met.
- Set department goals while implementing time management training, enhancing productivity and efficiency in claim adjudication through Operations that captured performance and reporting.
- Led claims payment adjustments for various lines of business, including Government FEP, Medicaid, Behavioral Health, HMO, and PPO while maintaining 48-hour turnaround time.
- Liaised between members, providers, management, credentialing, and IT to address system and human errors, ensuring accurate claims processing.
Education
Business Administration (ABA) -
Central Piedmont Community College
Charlotte, NCMedical Office Administration -
Metropolitan Career Center
Philadelphia, PAGeneral Studies -
Germantown High School
Philadelphia, PASkills
- Data Entry (Alpha/Numeric Keystrokes)
- Microsoft Office Suite Proficiency
- Medical Terminology
- ICD
- CPT Codes
- Google Meet
- Teams
- Zoom
- Slack
- EDI
- NAVINET
- Rosco
- Allscripts
- Cerner
- Availity
- EPIC
- Bookkeeper
- Jira ticketing system
- Cotiviti
- Cortex
- Faxblast
- Verint
- InContact
- Cisco Finesse
- Social Media Marketing Certification
Awards
Star Award, Recognized for initiative in enhancing institutional knowledge sharing, improving team efficiency, and consistently exceeding productivity and performance metrics.
Timeline
Care Specialist, Provider Escalations
Oscar Health Inc
05.2025 - Current
Authorization Coordinator, Utilization Management
Piedmont Medical Center
08.2023 - 04.2025
Production Lead/MRA Retrieval Specialist (Remote)
Humana Inc.
09.2012 - 02.2016
Benefit Verification Specialist
AmerisourceBergen
09.2010 - 03.2012
Provider Network Coordinator (Remote), Supervisor (Hybrid), Sr. Managed Care Claims Coordinator, Claims A/R Payment Adjuster
Independence Blue Cross
02.2000 - 07.2009
Business Administration (ABA) -
Central Piedmont Community College
Medical Office Administration -
Metropolitan Career Center
General Studies -
Germantown High School