Lisa Gillespie

• Effectively utilized electronic medical record systems for documentation purposes
• Implemented electronic systems for collecting data needed for HEDIS reporting
• Advised and educated provider practices in appropriate HEDIS measures, and HEDIS ICD-10 /CPT coding in accordance with NCQA requirements.
• Demonstrated empathy toward diverse patient populations, building trust through compassionate interactions.
• Enhanced patient satisfaction by addressing concerns and providing clear communication on treatment plans.
• Coordinated referrals to specialists, facilitating seamless continuity of care for patients with complex needs.

Coordinated communication between patients, family members, medical staff, administrative staff, or regulatory agencies

• Collaborated closely with multidisciplinary teams including physicians, nurses, social workers, physical therapists to ensure seamless coordination of care services
• Coordinated timely scheduling of appointments and follow-ups with physicians or other healthcare professionals based on individual needs
• Determined medical insurance eligibility in accordance with patient's current plan coverage
• Transmitted correspondence or medical records by mail or email
• Evaluated referrals for appropriateness prior to authorizing services according to established criteria.

• Provided exceptional customer service to patients, families, and healthcare providers by promptly responding to inquiries, addressing complaints, and resolving issues
• Utilized electronic health records system for accurate data entry of patient information such as demographics, insurance coverage, and physician orders
• Trained new patient care coordinators on medical terminology, procedures, and protocols
• Demonstrated knowledge of pharmaceutical terminology including generic and brand names and abbreviations
• Prepared appeals letters on behalf of patients who have been denied coverage by their insurance provider
• Successfully managed and developed a team of 10+ employees, demonstrating strong leadership skills
• Utilized critical thinking skills to analyze complex medical documentation for prior authorization requests
• Maintained up-to-date knowledge of insurance policies and procedures related to prior authorization requirements
• Utilized electronic health record systems and referral management software to document and track referral information.