Lisa Fleenor
Cincinnati,Ohio
Summary
Dynamic leader with extensive experience at UnitedHealthcare, excelling in provider relationship management and claims resolution. Proven track record in enhancing operational strategies and fostering cross-functional collaboration. Adept at process improvement, I successfully led initiatives that improved provider satisfaction and streamlined complex reimbursement challenges. Strong team leadership and issue resolution skills drive results.
Overview
27
27
years of professional experience
Work History
National Ancillary Provider Relations Assoc Director
UnitedHealthcare
05.2022 - 05.2025
- Led team of senior provider advocates managing strategic relationships across high-spend ancillary specialties (>20B), including Dialysis, Home Health, Home Infusion/Specialty Pharmacy, Hospice, Air Ambulance, Virtual/Urgent Care, Labs, DME Supply, Orthotics & Prosthetics, and Complex Rehab Oversaw complex Durable Medical Equipment (DME) contracts, ensuring alignment with contract intent, coding requirements, and exception terms.
- Special interests are Payment integrity, SIU, CES editing, internal and external collaboration to create a perception of positive transparent relationship.
- Promoted from Provider Relations Manager to expand leadership responsibilities across national strategy, operations, and cross-functional initiatives for all lines of business.
- Partnered with internal and external stakeholders to implement provider solutions that enhanced satisfaction and improved Net Promoter Scores (NPS) through process simplification.
- Delivered timely, effective communication and resolution updates to key stakeholders, ensuring adherence to service-level metrics (e.g., turnaround times).
- Resolved escalated provider issues leveraging deep expertise in claims payment, medical policy, coding (HCPCS, ICD-9, CPT/modifiers), Individual Medicaid State rules, and CMS reimbursement methodologies.
- Successful development of new team structures and processes with documentation for continued support.
- Collaborated with Payment Integrity, Special Investigations Unit (SIU), and Payment Policy teams, as well as WellMed and OptumCare, to develop system-wide solutions to reimbursement challenges.
- Led digital engagement efforts and provider education strategies for high-volume partners to enhance operational understanding and adoption of tools.
National Ancillary Provider Relations Manager
UnitedHealthcare
01.2014 - 05.2022
- Provided daily management and coaching of Senior Provider Relations Advocates.
- Oversaw functions related to provider servicing, provider education and network development as appropriate in each area National Ancillary team.
- Represented Provider Relations Department at management meetings and interacting with management and staff of other departments as necessary.
- Developed & maintained SharePoint's, database creations, created SOPs, job aids to document all specific processes for the National Provider relations team.
- Job Scope and Guidelines -- Set team direction, adapted departmental plans and priorities to address business and operational challenges.
- Influenced or provided input to forecasting and planning activities.
- Established and fostered strong, positive relationships with key providers by coordinating, facilitating, and leading partnership meetings and provider orientations.
- Influenced advocates to use resources and experience to identify information necessary to resolve customer issues and build their knowledge and skill.
- Created environment in which Advocates were empowered to ask for additional training and coaching.
National MSA Manager
UnitedHealthcare
04.2011 - 01.2014
- Provided daily management and coaching of National MSAs.
- Monitored team activities assuring staff meets performance standards and operating effectively and efficiently.
- Handled escalated claims/operational issues by taking action to assure timely resolution of provider issues.
- Monitored staff workloads and recommends distribution of work.
- Provide coaching and training to direct reports and other parts of team as needed.
- Participate in development of presentations and training modules for ancillary business.
- Interfaced with all other departments to ensure appropriate process to address claims and operational issues.
- Participate in standing meetings as necessary for National Ancillary Providers and National Hospitals.
- Created standard operating procedure job aids for dedicated processes for National Provider relations team.
SE GA Hospital and Facility Advocate
UnitedHealthcare
04.2009 - 04.2011
- Hospital and Facility Advocate for Ga Level 1&2 providers.
- Facilities included but not limited to: Northside Hospital, Medical College of Ga, Houston, Emory, MCCG, Wellstar, and Gwinnett.
- Acted as SME for facilities with escalated/complex issues requiring special handling due to arbitration, term on table, and DOI issues.
- Promoted consistent claim handling for providers-worked closely with GA Network Management team.
- Primary goal: create positive service experience for providers.
SE GA MSA
UnitedHealthcare
07.2008 - 04.2009
- Worked on end-to-end provider complex claim issues and deliver resolution.
- Educated providers and staff on using portal and provide updates on future service enhancements.
- Built and maintained professional relationships with providers to ensure provider satisfaction.
- Prioritized and organized own work to meet deadlines.
- Identified issues, analyzed information and provided solutions to problems.
- Participated in team-building activities to enhance working relationships.
Provider Appeals Analyst
UnitedHealthcare
12.2003 - 07.2008
- Served as Central Escalated Unit (CEU) provider appeal Liaison.
- Preceptor for trainees.
- Sit on Quality/Quality Tools, and PAO Training Opportunities Calls.
- Act as SME, Trainer, High Dollar reviewer.
- Additional, R&C, MAHP, California providers, DOI and EXEC complaints.
- Serve as ETS system tester.
- Functioned as Escalated Appeal Liaison.
Business Info Specialist
Aetna
New Albany, Ohio
12.1997 - 12.2003
- Led testing initiatives for automatic claim adjudication system, ensuring accuracy and efficiency.
- Developed test scripts for all conversions, addressing unique needs of sensitive customers.
- Trained processors on testing procedures for each conversion, enhancing team capabilities.
- Executed test plans for group intent loads, validating results meticulously.
- Conducted user acceptance testing for annual group updates to verify compliance and functionality.
- Collaborated with plan sponsors, account managers, and team leads on automated system support.
- Participated in auditing and testing plan wording to ensure alignment with business intent.
- Supported manual and automated plan setups, contributing to seamless transitions.
Education
High School Diploma -
River View High School
Warsaw, OHSkills
- Provider relationship management
- Claims and reimbursement
- Network development
- Operational strategy
- Utilization management
- Team leadership
- Cross-functional collaboration
- Issue resolution
- Process improvement
Training
- UnitedHealthcare Manager Program
- UnitedHealthcare Emerging Leaders Program
- Fair Play Life Program
Timeline
National Ancillary Provider Relations Assoc Director
UnitedHealthcare
05.2022 - 05.2025
National Ancillary Provider Relations Manager
UnitedHealthcare
01.2014 - 05.2022
National MSA Manager
UnitedHealthcare
04.2011 - 01.2014
SE GA Hospital and Facility Advocate
UnitedHealthcare
04.2009 - 04.2011
SE GA MSA
UnitedHealthcare
07.2008 - 04.2009
Provider Appeals Analyst
UnitedHealthcare
12.2003 - 07.2008
Business Info Specialist
Aetna
12.1997 - 12.2003
High School Diploma -
River View High School