Lisa Lewis
New Baltimore,MI
Summary
Results-driven professional with 28 years of experience in customer care, billing, and team leadership. Skilled in process analysis, identifying inefficiencies, and implementing improvements to enhance operational efficiency and compliance. Proven ability to collaborate with teams, develop documentation, and resolve complex issues to drive customer satisfaction and business success. Seeking to leverage strong analytical and leadership abilities as a Business Process Analyst.
Overview
35
35
years of professional experience
Work History
Intake Coordinator, Utilization Management
Highmark, Inc.
Pittsburg, PA
03.2022 - Current
- Enhanced role scope and took on more responsibilities as a full-time team member.
- Analyzed member plans and gathered documentation to build cases in the Utilization Management system, ensuring accuracy to meet compliance requirements.
- Leveraged critical problem-solving to evaluate cases needing escalations or additional notifications for providers and members.
- Utilized INSINQ software tools to verify benefit eligibility and streamline documentation processes.
- Collaborated with cross-functional teams to support case progression and issue resolution.
- Compiled and processed faxes for case building and triage, maintaining compliance with healthcare industry standards.
- Demonstrated strong oral and written communication skills, effectively solving problems and making informed decisions within the health insurance sector.
Intake Coordinator, Utilization Management/Contractor
SGS Consulting
Princeton, NJ
11.2021 - 03.2022
- Ensured the accuracy of patients' identity and insurance details before communicating authorization updates.
- Conveyed the status of authorization requests to the providers and members with precision and clarity. using the case management system to update them on prior authorization status, ensuring compliance.
- Provided clear and accurate updates on prior authorization statuses, including approvals, denials, and pending cases, aligned with insurance policies.
- Executed over 15-20 calls per hour to meet daily goals, providing updated information on prior authorizations to providers and members.
- Achieved and maintained a 100% quality audit score while surpassing monthly communication call-out objectives.
- Communicated the required follow-up actions to the providers and members, promoting clarity and compliance.
- Captured detailed communication with members and providers, and captured information in the case notes.
Customer Care Supervisor / Billing Specialist
Bright House Networks/Charter Communications
Livonia, MI
02.1990 - 08.2018
- Led and trained teams in a high-volume inbound/outbound call center, achieving goals in service levels, abandonment rates, and customer satisfaction.
- Streamlined billing processes by conducting audits, identifying discrepancies, and proactively addressing errors, increasing accuracy and efficiency.
- Collaborated with the team to enhance and document business processes, ensuring consistency and compliance across the department.
- Worked with cross-functional teams to implement and optimize a billing audit tool, automating checks, identifying real-time errors, and generating actionable reports.
- Utilized Workforce Management (WFM) tools to monitor schedules, adjust staffing levels, and ensure adherence to service-level agreements, reducing downtime, and optimizing resources.
- Conducted performance monitoring and provided coaching to ensure team alignment with departmental goals.
- Reconciled payroll data in Kronos and ADP systems to ensure accuracy.
Education
NHA Certification CMAA - Certified Medical Administration Assistance
Central Michigan University
Mount Pleasant, MI03-2021
CPC Certified Medical Administrative Assistant With Medical Billing And Coding in Medical Billing & - Medical Billing And Coding Training
Central Michigan University
Mount Pleasant, MI01-2021
High School Diploma -
Highland Springs High School
Highlands Springs, VACoursework in - Accounting/Computer Information Systems
Davenport University
Warren, MICoursework in - Business Administration
Macomb Community College
Macomb, MISkills
Process Improvement and Analysis
Operational Efficiency
Collaborative Problem-Solving
Leadership and Team Development
Customer Satisfaction Strategies
Compliance and Documentation
Data Accuracy and Auditing
Conflict Resolution and Decision-Making
Key Accomplishments
- Designed and facilitated weekly training programs to mentor staff, resulting in increased team productivity and accuracy.
- Reduced billing discrepancies by 15% through audits and proactive analysis.
- Improved team efficiency and morale through effective leadership, reducing call escalation rates by 20%.
Skills
- Process Analysis: Identifying inefficiencies and opportunities for improvement.
- Operational Efficiency: Implementing changes to improve workflows and compliance.
- Collaboration: Working with teams to develop and document processes.
- Problem-Solving: Resolving complex issues to drive results.
- Leadership: Managing teams and fostering a productive environment.
Technically Skills
- Software: CRM systems, CSG billing System, Kronos, ADP, MS Office Suite (Excel, Word, PowerPoint)
- Tools: Case Management Systems, Utilization Management Systems, Billing Audit Tools
Timeline
Intake Coordinator, Utilization Management
Highmark, Inc.
03.2022 - Current
Intake Coordinator, Utilization Management/Contractor
SGS Consulting
11.2021 - 03.2022
Customer Care Supervisor / Billing Specialist
Bright House Networks/Charter Communications
02.1990 - 08.2018
NHA Certification CMAA - Certified Medical Administration Assistance
Central Michigan University
CPC Certified Medical Administrative Assistant With Medical Billing And Coding in Medical Billing & - Medical Billing And Coding Training
Central Michigan University
High School Diploma -
Highland Springs High School
Coursework in - Accounting/Computer Information Systems
Davenport University
Coursework in - Business Administration
Macomb Community College
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