Summary
Overview
Work History
Education
Skills
Timeline
Generic

Lisa Regusters

Brooksville

Summary

Dedicated Care Advocate with expertise in healthcare navigation, HIPAA compliance, and effective communication. Proven ability to resolve member inquiries and support care coordination.

Overview

10
10
years of professional experience

Work History

Care Advocate

Accolade Inc
Plymouth Meeting
03.2020 - Current
  • Assisted members in navigating healthcare options and resources.
  • Provided support for care coordination and follow-up services for patients.
  • Documented interactions in the case management system accurately and timely.
  • Resolved member inquiries regarding claims, benefits, and services effectively.
  • Maintained up-to-date knowledge of healthcare policies and industry trends.
  • Facilitated communication between members, providers, and internal teams efficiently.
  • Conducted complex research, review and analysis of medical records, treatment plans and claim information.
  • Communicated with insurance offices to verify service eligibility for authorization requests.
  • Applied HIPAA privacy and security regulations while handling patient information.
  • Reviewed eligibility responses to assess patient benefit level and prepare estimates.
  • Collaborated with insurance companies to resolve billing discrepancies and pre-certification issues.
  • Handled high volume of incoming calls, providing exceptional customer service to patients and families.

Account Executive

CareersUSA
Philadelphia
03.2019 - 12.2019
  • Coordinated marketing campaigns to enhance brand visibility and customer engagement.
  • Collaborated with cross-functional teams to align on client needs and deliver solutions.
  • Analyzed client feedback to improve service offerings and address concerns promptly.
  • Provided timely customer service support to resolve any issues quickly and efficiently.
  • Cultivated relationships with key decision makers through regular client visits and follow-up calls.
  • Attended networking events to build relationships with potential customers.
  • Used excellent verbal skills to engage customers in conversation and effectively determine needs and requirements.
  • Identified customer needs by asking questions and advising on best solutions.
  • Recruited, hired and trained new hires to optimize profitability.

Claims Support Specialist

Capgemini
Horsham
09.2015 - 10.2018
  • Processed claims documentation efficiently for timely resolution.
  • Reviewed policy details to ensure compliance with company standards.
  • Communicated effectively with clients to gather necessary information.
  • Collaborated with team members to streamline claims processing workflows.
  • Assisted in training new staff on claims support procedures and systems.
  • Analyzed client inquiries to provide appropriate solutions promptly.
  • Maintained organized records of claims for easy retrieval and review.
  • Adhered to established protocols when conducting research into historical claims data.
  • Performed data entry into internal systems to ensure accurate tracking of claim activity.
  • Verified coverage eligibility for customers through review of policy documents or contact with insurers.
  • Assisted customers with filing new claims and provided guidance throughout the process.
  • Answered customer inquiries regarding claim status and payment information.
  • Processed requests for refunds or adjustments due to overpayments or other errors.
  • Checked documentation for appropriate coding, catching errors and making revisions.
  • Prepared and reviewed insurance-claim forms and related documents for completeness.

Education

High School Diploma -

Cardinal Dougherty High School
Philadelphia, PA
06-2001

Skills

  • Healthcare navigation
  • HIPAA compliance
  • Customer relationship management
  • Data entry accuracy
  • Problem solving
  • Effective communication
  • Time management
  • Healthcare
  • Phone and email etiquette
  • Multitasking and organization
  • Health insurance knowledge
  • Customer service
  • Verbal and written communication
  • Multitasking

Timeline

Care Advocate

Accolade Inc
03.2020 - Current

Account Executive

CareersUSA
03.2019 - 12.2019

Claims Support Specialist

Capgemini
09.2015 - 10.2018

High School Diploma -

Cardinal Dougherty High School

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