Overview
Work History
Timeline
Generic

Lisa Reynolds

Linthicum,MD

Overview

29
29
years of professional experience

Work History

Senior Director of Operations, Client Success & Optimization

Versant Health (subsidiary of MetLife Inc.)
Linthicum
01.2021 - 01.2024
  • Partner with the Client and Client Manager to identify client operation program opportunities and risks
  • Responsible for the success of client operational strategic enhancements and process optimization and improvements
  • Identify points of operational failure and works to mitigate and ultimately eliminate
  • Prepare and present executive and client-ready presentation materials related to operation strategic enhancements and process optimization
  • Develop client scorecard reporting to demonstrate impact of strategic enhancements
  • Collaborate and partner closely with cross-functional teams to ensure successful realization of client goals, deliverables and member and provider satisfaction
  • Attract, mentor, and develop next-generation high-potential internal and external talent
  • Synthesize data to develop strategic and operational implications that translate into action
  • Optimize client deliverables such that they are of the highest quality, repeatable, automated, and fail safe
  • Communicate a consistent cadence of information to senior leadership highlighting operational performance

Director of Operations

Versant Health (subsidiary of MetLife Inc.)
Linthicum
01.2016 - 01.2021
  • Direct the operations teams to include selection, training/development, coaching, counseling, and performance management
  • Establish and successfully communicate claims department goals and objectives together with managers and supervisors set goals and expectations; perform associate evaluations and provide coaching as appropriate
  • Executive oversight over third party payment processing vendor, including paper checks, electronic funds transfer, explanation of payments, and explanation of benefits
  • Implement and manage processes to ensure timely and accurate processing of claims, including reconciling and auditing of claims submitted
  • Adhere to all state Medicaid and Medicare regulations with 98% accuracy
  • Provide statistical analysis of claims flow and production results
  • Provide client service and technical support, including data analysis, troubleshooting, and issue resolution
  • Identify and develop enhancements to the claims process, including scanning, vertexing, workflows, system software, etc
  • Develop and manage corrective action and quality improvement plans
  • Ensure full compliance for all accreditations and governmental ratings
  • Maintain departmental documentation, internal and external certifications
  • Establish and monitor successful adherence to claims department guidelines, performance standards, and goals
  • Improve internal processes by examining trends, claim statistics, and provider payments
  • Reduce financial exposure to the organization through the imposition of appropriate controls on provider payments by managing the workflow of claims examiners and by ensuring that all claim entries are within established prompt payment goals
  • Mitigate risks to company by effectively responding to client audit requests, and conducting ongoing monitoring and auditing of claims staff with special emphasis on payment accuracy
  • Work collaboratively with other department to identify, correct, and improve computer systems, internal processes, business requirements, and enhancements.

Manager of Claims

Versant Health (subsidiary of MetLife Inc.)
Linthicum
01.2015 - 01.2016
  • Responsible for providing daily management of the Claims Department for a team of approximately fifteen associates
  • Daily management of claims intake, inventory control, claims processing, auditing, fulfillment for payment, compliance with prompt pay requirements, group and system reporting, and financial recovery
  • Worked collaboratively with supervisors to oversee personnel issues including hiring support, motivating, recognizing and rewarding, coaching, training, and problem solving.

Senior Business Analyst

UFCW & Employers Benefit Trust
Roseville
01.2011 - 01.2015
  • Provided expert oversight on several project teams responsible for process improvement, policy changes, and vendor implementations
  • Monitored trends and developments within the health care industry, and provided recommendations to senior leaders on improving claims operations
  • Streamlined claims review process by reviewing and creating new process for adjudication of medical claim payments
  • Increased consistency and compliance with client contracts by conducting a thorough assessment of communication materials issued to members in close collaboration with the communications department and plan consultants
  • Exceeded client expectations by configuring and implementing claims payment modules based on introduction of new plan rules and provisions
  • Conduct system audits and new program implementations to ensure accurate programming for quality control, including ICD-9 to ICD-10 conversion, claims auto-adjudication, enterprise software conversion, data collection/analysis for Department of Labor audits, and data collection/analysis for class action lawsuits.

Claims Supervisor

UFCW & Employers Benefit Trust
Roseville
01.2006 - 01.2011
  • Supervised claim department consisting of 26 claim examiners with 13 direct reports
  • Responsible for the day–to-day operations of the claims department to achieve maximum work group productivity
  • Developed team management skills by evaluating team members, providing performance appraisals, recognizing accomplishments of team members, engaging in hiring decisions, and conducting disciplinary actions
  • Acted as liaison officer between the member services department, union local clerks, and the claims department in order to resolve operational and compliance issues and concerns
  • Achieved member and provider satisfaction by addressing their complaints concerning claims.

Lead Medical Claim Adjuster

UFCW & Employers Benefit Trust
Roseville
01.1997 - 01.2006
  • Responsible for researching and processing specialized and unusual claims, including processing refunds, appeals, employee claims, and third-party liability claims.

Claim Adjuster

UFCW & Employers Benefit Trust
Roseville
01.1995 - 01.1997
  • Responsible for analyzing, reviewing, and processing medical and sick leave disability claims in accordance with plan benefits, rules, and guidelines
  • Provided written and verbal communication to members, plan participants, claimants, service providers, and outside insurance carriers.

Timeline

Senior Director of Operations, Client Success & Optimization

Versant Health (subsidiary of MetLife Inc.)
01.2021 - 01.2024

Director of Operations

Versant Health (subsidiary of MetLife Inc.)
01.2016 - 01.2021

Manager of Claims

Versant Health (subsidiary of MetLife Inc.)
01.2015 - 01.2016

Senior Business Analyst

UFCW & Employers Benefit Trust
01.2011 - 01.2015

Claims Supervisor

UFCW & Employers Benefit Trust
01.2006 - 01.2011

Lead Medical Claim Adjuster

UFCW & Employers Benefit Trust
01.1997 - 01.2006

Claim Adjuster

UFCW & Employers Benefit Trust
01.1995 - 01.1997

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Lisa Reynolds