Lisa Crockett

Dedicated Provider Specialist with extensive experience in assistance with Medical/Dental claims research, eligibility, and Clinical Appeal/Disputes.

Skilled with Authorizations Medical/Pharmacy, Coordination of Benefits and facilitating the Provider enrollment process.

Proficient in collaborating with the Issue Resolution Team to utilize online Provide Directory tool for verifying and updating provider profiles, ensuring the accuracy in the system.

Experienced in researching provider contract status thru the State Medicaid files and Facets system, submitting tickets for necessary updates to provider data management.

Adept at reaching out to providers via phone and email to guide them on submitting maintenance request to resolve discrepancies and meet timelines.

Additionally, I have contributed to the successful onboarding new hires with nesting after their training completion, fostering a supportive learning environment.

Maintain the accounts receivable records and collect delinquent accounts of patients by performing specific job tasks.

Review each patient/customer accounts receivable file to determine next plan of action.

Reprint and mail claims, invoices and statements.

Follow up with insurance companies and vendors by phone to determine what steps need to be taken in order to get payment processed.

Submit documentation to insurance companies per request to facilitate payment processing.

Call and/or mail correspondence to insurance companies, patients and customers as necessary to determine reason for overdue payment to update the account.

File and follow up on specific appeals as needed to facilitate the collection of the claim.

Sort, scan and electronically file all correspondence and documentation regarding denials, appeals.

Submit adjustments and write-off requests on non-collectable accounts.

Entered details such as payments, account information and call logs into the computer system.

• Provided excellent customer service by addressing inquiries from both clients and insurance providers in a timely manner.

Provided technical assistance to individuals and/or businesses primarily through telephone interaction in a dynamic call center environment.

Address wide range of issues/problems that require unique solutions.

Apply the tax code to assist taxpayers in understanding and meeting their tax responsibilities.

Secure, analyze and protect sensitive personal and financial information.

Recognized for the ability to listen attentively and respond to each customer inquiry; and providing quick resolutions to customer issues.

Efficiently handle a high volume of customers while maintaining a focus on delivering exceptional customer service.

• Provided telephone support to healthcare providers, resolving issues and assisting with updates to provider files.
• Delivered unbiased information on Indiana Health Coverage Program entities and health plans to ensure providers were well-informed.
• Reviewed Explanation of Benefits (EOBs) with members and providers, collaborating with Provider Relations staff to address complex issues and document resolutions.
• Maintained confidentiality and ensured compliance with HIPAA regulations.
• Assisted providers with medical claim inquiries and credentialing issues, streamlining processes for Physicians, Hospitals, and DME.
• Collected and processed verification and accreditation information to maintain and update Indiana Medicaid credentialing.
• Managed the credentialing process, including applications, re-applications, and attestations, ensuring all providers met required standards.
• Conducted monthly reviews to verify provider licenses, insurance, and work history, maintaining strong relationships with providers and health plans.
• Streamlined communication between departments, enhancing overall workflow and reducing processing times.
• Coordinated with multiple departments to ensure compliance with healthcare regulations, maintaining accreditation standards.

• Responded to customer inquiries via phone and written correspondence regarding insurance benefits, provider contracts, eligibility, and claims.
• Assisted providers in reconciling claims and reviewed Explanation of Benefits (EOBs) with both members and providers.
• Analyzed problems and provided information solutions while operating a PC/image station to extract and document data effectively.
• Thoroughly documented inquiry outcomes for accurate tracking and analysis of customer interactions.
• Researched and analyzed claims data to address operational challenges and improve customer service.
• Developed and maintained positive customer relations, coordinating with various company functions to ensure timely resolution of customer requests.
• Served as a Customer Grievance Advocate for the Aged, Blind, and Disabled Medicaid population in Ohio, addressing continuity of care, deferments, and dis-enrollment issues.
• Promoted superior experience by addressing customer concerns, demonstrating empathy, and resolving problems swiftly.
• Assisted in locating specialist doctors and resolving transportation issues for Just Cause Cases with Anthem Blue Cross Blue Shield.
• Demonstrated excellent interpersonal skills, effectively managing difficult customer situations, including escalated cases.
• Resolved disputes, billing discrepancies, and claims efficiently to enhance customer satisfaction.