Lisa Mason

Manages a health system level service for enrollment of employed providers, facilities and other entities within UMMS with governmental payers for purposes of claims submission.

• Collects, monitor and analyzes enrollment operations performance data relative to established goals and metrics to identify potential risks and/or areas of opportunity and prepares action plans for improvement.
• Participates in acquisition/integration teams and oversees enrollment related responsibilities.
• Verify organizational NPI NPPES accounts are up-to-date and accurate with appropriate facility and medical group taxonomy information.
• Maintain institutional and provider group files to include up to date information needed to complete required governmental payer applications.
• Review records for completeness, accuracy, and compliance with regulations
• Develop and implement organizational policies and procedures for government payer enrollment.
• Communicated effectively via telephone, email, and in person with prospective customers.

• Maintain individual providers and group files to include up to date information needed to complete required governmental and commercial payer credentialing applications.
• Complete revalidation requests issued by government payers. Complete initial credentialing and re-credentialing applications for providers/practices. Review enrollment records for completeness, accuracy, and compliance with regulations.
• Compile and maintain patients' medical records to document condition and treatment and to provide data for cost control and care improvement efforts.
• Analyze and resolve payor reimbursement issues through in-depth research and analysis of claim data, payor policies, regulations, and coverage criteria.
• Work closely with CFO and billing staff to identify and resolve any denials or authorization issues related to provider credentialing.
• Maintain accurate provider profiles on CAQH, ePREP, PECOS, NPPES, and payer web-portals. Review enrollment records for completeness, accuracy, and compliance with regulations.
• Resolve and/or clarify CPT and/or or diagnoses codes with conflicting, missing, or unclear information in conjunction with clinical staff.
• Direct, supervise and evaluate work activities of billing staff.
• Provided follow through with Office Staff to ensure fast and proper implementation of new payer policies.
• Direct or conduct recruitment, hiring and training of personnel.
• Establish work schedules and assignments for staff, according to workload, space and equipment availability.
• Planned and implemented staff development and in-service training programs to enhance knowledge and skills.

• Ensure that policy requirements are fulfilled, including any necessary medical examinations and completion of appropriate forms
• Explain features, advantages and disadvantages of various policies to promote sale of insurance plans
• Perform administrative tasks, such as maintaining records and handling policy renewals
• Contact underwriter and submit forms to obtain binder coverage
• Attend meetings, seminars and programs to learn about new products and services, learn new skills, and receive technical assistance in developing new accounts
• Explain necessary bookkeeping requirements for customer to implement and provide group insurance program.

• Set up and manage paper or electronic filing systems, recording information, updating paperwork, or maintaining documents, such as medical records, correspondence, or other material.
• Open, read, route, and distribute incoming mail or other materials and answer routine letters.
• Maintain scheduling and event calendars.
• Conduct searches to find needed clinical studies, using such sources as medical library and web searches.
• Authorize drug refills and provide prescription information to pharmacies.
• Authorize surgical procedures, medical equipment, and medications.
• Obtained surgery authorizations after insurance company verification.
• Monitored and updated medical charts on regular basis.
• Maintained and updated surgery schedule.
• Prepared and submitted medical transcription and order reports.
• Responded to patient and staff queries by telephone and e-mail.
• Kept information confidential and followed HIPAA guidelines to maintain patient trust.
• Registered new patients in electronic medical records prior to appointment scheduling.
• Maintained current and accurate medical records for patients.
• Enhanced office productivity by handling high volume of callers per day.