LISA BOLAÑOS
Santa,CA
Summary
Driven Manager in Client Billing with expertise in healthcare and healthcare management. Including insurance benefits, claims, cost share, and determining clients' needs. In-depth knowledge of claims processing, database management, correspondence, escalations along with customer and patient care. Outstanding analytical, interpersonal and organizational skills. Dedicated to expediently resolving insurance issues and exceeding client expectations.
Overview
27
27
years of professional experience
Work History
Manager, Client Billing
Lyra Health
11.2024 - Current
- Currently building new Client Billing Team
- Creating client billing case logic, workflow, processes and policies
- Collection outstanding cost share
- Invoice clients
- Creating automation for invoicing client cost share
- Manually charge client credit cards
- Refund clients
- Create payment plans
- Creating automation for handling accumulators for client cost shares
- Verified insurance coverage by telephone and online to guarantee proper reimbursement of benefits and estimate patients' financial responsibilities.
- Conducted annual reviews of existing policies to update information.
- Investigated claims
- Lead multiple projects resulting in high cost share collections.
- Assisted in building, implemented and training on new systems, software and applications.
- Tested new system updates and QA all employee work.
- Handle all escalated client calls, including calls regarding eligibility, benefits, claims, cost share, provider issues, account issues.
- Handle HSA/FSA payments, including posting to accounts.
- Creating new educational documentation for clients.
Lead Health Plan Operations
Lyra Health
07.2021 - 10.2024
- Built and managed Collections Team
- Created collections logic, workflow, processes and policies
- Collection outstanding cost share
- Invoice clients
- Manually charge client credit cards
- Create payment plans
- Handle accumulators for client cost shares
- Verified insurance coverage by telephone and online to guarantee proper reimbursement of benefits and estimate patients' financial responsibilities.
- Performed needs analysis to obtain information required to make appropriate health insurance product recommendations.
- Conducted annual reviews of existing policies to update information.
- Investigated claims
- Submitted manual claims
- Lead multiple projects resulting in high cost share collections.
- Assisted in building, implemented and training on new systems, software and applications.
- Tested new system updates and QA all employee work.
- Handled all escalated client calls, including calls regarding eligibility, benefits, claims, cost share, provider issues, account issues.
- Handled HSA/FSA payments, including posting to accounts. Created new educational documentation for clients.
Patient Service Representative Coordinator
Palo Alto Medical Foundation
01.2017 - 07.2021
- Coordinate daily Patient Service Representatives.
- Monitor all surgeons schedules for Urology, General Surgery and Plastic Surgery.
- Build daily schedules for departments.
- Assist back office staff with any day to day needs.
- Train incoming employees.
- Develop and implemented department workflows and processes.
- Answer phones and schedule appointments for multi departments.
- Problem solve issues for Physician's and departments.
- Handle all incoming referrals for multi departments.
- Assist patients with billing and customer service issues.
- Maintain and update demographic information on patients medical record.
- Created all staff schedules.
- Handle safe and daily cash bag for multi departments.
- Covered in multi departments when no staffing.
- Verify and update patient insurance.
- Assisted in mass COVID vaccine site by developing and implementing workflows and processes for 2,000+ daily patient intake.
- Managed Patient Service Representatives for mass COVID vaccine site.
Patient Access Supervisor
El Camino Hospital
01.2013 - 12.2016
- Supervised all Patient Access departments for Los Gatos site.
- Assisted in building and implementation of new hospital EHR system.
- On call for both Mountain View and Los Gatos site(had to be available to assist staff 24 hours).
- Created all staff schedules for both multiple sites.
- Worked all work queues (which included all Patient Access errors) for multiple sites.
- Handled safe and petty cash for Hospital.
- Problem solve issues for all hospital Physician's and departments.
- Covered in multi departments when no staffing.
- Build daily schedules for departments.
- Train incoming employees.
- Develop and implemented department workflows and processes.
- Handle all incoming referrals for multi departments.
- Assist patients with billing and customer service issues.
- Maintain and update demographic information on patients medical record.
- Handle safe and daily cash bag for multi departments.
- Covered in multi departments when no staffing.
- Verify and update patient insurance.
Patient Registration Representative
El Camino Hospital
01.2007 - 01.2013
- Register all incoming Emergency Department patients.
- Update and record patient insurance and demographic information.
- Admit all night shift patients for hospital and labor /delivery.
- Assign patients to appropriate room and unit.
- Collect copays.
- Answer Register/Admitting calls (including Emergency Department, Labor and Delivery).
- Handle all ambulatory registration including code and stat patients.
- Heavy data entry.
- One on one patient contact.
- Pre-admit incoming Labor and Delivery patients.
Account Representative Specialist
Camino Medical Group
01.2000 - 03.2006
- Claims submission and correction.
- Some coding for claims.
- Register all new incoming patients.
- Verify eligibility and benefits with insurance companies.
- Setup insurance records for billing purposes.
- Update insurance records for billing purposes.
- Handle any incoming insurance questions.
- Schedule and check-in patients.
- Take co-payments.
- Answer multi-line phones & transferring calls.
- Close out money drawers.
- Heavy data entry.
- Train incoming employees.
- Assisted manager with projects when needed.
- Assisted patients.
Patient Service Representative
Camino Medical Group
01.1998 - 01.2000
- Answering very heavy phones & Transferring calls.
- Taking messages & Scheduling appointments.
- Checking in patients & taking co-payments.
- Preparing and maintaining patient charts.
- Locating and retrieving patient charts.
- Calling back messages for doctors.
- Preparing and creating doctors schedules.
- Register new patients.
- Assist medical assistants & doctors when needed.
- Close out money drawers.
- Assisting drug representatives & visitors when needed.
Skills
- Developing workflows, processes and policies
- Health insurance
- Policy analysis
- Patient and Customer Assistance
- Attention to detail
- Cost Share Collection
- Critical thinking
- Staff Management
- Strategic Planning
- Employee training
- Developing new teams
System Knowledge
- EPIC
- Saleforce
- Zendesk
- Tableau
- Stripe
- Change Healthcare
- Asana
- Workday
- Postico / SQL
- Terminal
- Confluence
- Jira
- Health Plan portals
Timeline
Manager, Client Billing
Lyra Health
11.2024 - Current
Lead Health Plan Operations
Lyra Health
07.2021 - 10.2024
Patient Service Representative Coordinator
Palo Alto Medical Foundation
01.2017 - 07.2021
Patient Access Supervisor
El Camino Hospital
01.2013 - 12.2016
Patient Registration Representative
El Camino Hospital
01.2007 - 01.2013
Account Representative Specialist
Camino Medical Group
01.2000 - 03.2006
Patient Service Representative
Camino Medical Group
01.1998 - 01.2000
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