Lisa Ricafrente
Little Elm,TX
Summary
Solutions-driven and empathetic Senior Patient Services professional with extensive experience in the revenue cycle, including patient benefits, insurance, claims, pre-authorizations, referrals, and financial assistance. Recognized for leveraging innovative thinking and dynamic communication skills to foster positive relationships and enhance patient experiences. Adaptable and dedicated, consistently making a lasting impact in fast-paced environments. Proficient in various EMR programs with a strong technical aptitude for rapidly mastering new systems.
Overview
11
11
years of professional experience
1
1
Certification
Work History
Senior Patient Benefit Specialist
TEXAS ONCOLOGY – FRISCO WEST
06.2023 - Current
- Obtain, verify, and educate patients on insurance benefits, co-pays, deductibles, and out-of-pocket expenses before treatment. Assess ability to meet expenses, discuss/establish payment arrangements. Identify financial assistance programs, internal and external, and assist patients in completing forms, submitting to appropriate program for consideration. Policies included private, commercial, Medicare and Medicaid insurance.
- Effectively communicate with patients and caregivers, using emotional intelligence (EQ) and empathy, to discuss financial implications of treatment and offer resources. Provide understanding and support during times of need while remaining professional.
- Work cross-functionally with Clinical Reviewers to identify and obtain necessary pre-authorizations and/or referrals according to CPT and ICD-10 codes and treatment plans for chemotherapy/radiation. Create Patient Liability Estimate forms based upon diagnosis, estimate insurance coverage, and financial assistance. Scan documents into EMR system, submit to billing office, set up payment plans.
- Define requirements, identify, research, and resolve complex issues within clinic Revenue Cycle - claims rejections and denials, patient eligibility, coordination of benefits, pre-existing conditions, and non-payment. Contact payers and patients, work with Billing Department for appeals, audits, and claim resolutions. Enter account adjustments for write-offs, free medication, bad debt.
Credentialing & Compliance Manager
LIQUIDAGENTS HEALTHCARE
04.2022 - 06.2024
- Completed 100% credentialing and onboarding for healthcare providers traveling on assignment to hospitals throughout the United States.
- Saved, uploaded, and tracked sensitive provider documentation into LaborEdge – Medical, licenses, training, certifications, sanctions, HR, and hospital documents. Always maintained HIPAA privacy.
- Worked collaboratively and cross-functionally to communicate daily with Sales, Recruiting, healthcare providers, and hospitals to provide timely file updates, identified potential issues for pushes or cancellations, and addressed urgent concerns to resolution.
- Uploaded credentialing items to online VMS sites, such as Aya, HealthTrust, AMN, etc. Resolved unapproved items to meet or exceed timeline for assignment clearance.
- Conducted extensive background, education, and employment verification checks, sent electronic I-9, assigned exams, set up drug screens, medical titers, physicals, mask fit test as needed per assignment. Prioritized all tasks with sense of urgency to meet or exceed deadlines.
- Maintained database and analyzed data for quarterly and annual audits of employee files by JCAHO standards.
- Educated, trained and instructed Compliance Specialists on business practices, addressed questions, provided direction/retraining when required. Advised of new processes and guidelines.
- Achieved promotion from Compliance Specialist to Compliance Manager within three months of employment. Accomplished 96% clearance rating with VMS vendors.
Senior Patient Benefit Specialist
TEXAS ONCOLOGY – PLANO WEST
05.2021 - 04.2022
- Obtain, verify, and educate patients on insurance benefits, co-pays, deductibles, and out-of-pocket expenses before treatment. Assess ability to meet expenses, discuss/establish payment arrangements. Identify financial assistance programs, internal and external, and assist patients in completing forms, submitting to appropriate program for consideration. Policies included private, commercial, Medicare and Medicaid insurance.
- Effectively communicate with patients and caregivers, using emotional intelligence (EQ) and empathy, to discuss financial implications of treatment and offer resources. Provide understanding and support during times of need while remaining professional.
- Work cross-functionally with Clinical Reviewers to identify and obtain necessary pre-authorizations and/or referrals according to CPT and ICD-10 codes and treatment plans for chemotherapy/radiation. Create Patient Liability Estimate forms based upon diagnosis, estimate insurance coverage, and financial assistance. Scan documents into EMR system, submit to billing office, set up payment plans.
- Define requirements, identify, research, and resolve complex issues within clinic Revenue Cycle - claims rejections and denials, patient eligibility, coordination of benefits, pre-existing conditions, and non-payment. Contact payers and patients, work with Billing Department for appeals, audits, and claim resolutions. Enter account adjustments for write-offs, free medication, bad debt.
Patient Services Specialist III
BAYLOR SCOTT & WHITE – DALLAS DIAGNOSTIC ASSOCIATION
11.2019 - 05.2021
- Provided expert-level case research, escalation and resolution to patients and providers, in large outpatient Primary and Specialty clinic, including Internal Medicine, Radiology, Endocrinology, Pulmonology, Neurology, Rheumatology, Infusion, Dermatology, and Geriatric practices, with full-service Lab, HIM, and Supply Chain departments.
- Conducted in-depth insurance/benefit verification and issue resolution, processed referrals and pre-authorizations for high-cost specialty pharmacy infusion medications. Performed detailed documentation of correspondence and interactions in Epic.
- Analyzed/audited unpaid claims for posting and contractual adjustment errors, denials, coding disputes, medical necessity, and debits and credits on current and delinquent accounts. Discussed financial issues with patients. Pre-certification of patient financial assistance application and supporting documentation for submission to Financial Assistance Approval department.
- Worked cross-functionally in Epic charge review WQS with Revenue Cycle, Legal, Compliance, and Practice Management to resolve patient account inquiries, write-offs, administrative adjustments, and insurance claim resubmissions.
- Instrumental in identifying duplicate medical records, bad addresses, multiple insurance entries/guarantor accounts through reporting tools to develop workflow processes to aid in prevention/resolution of items and improve data integrity, providing for process improvement and refinement to patient registration practices.
Patient Service Representative – Intermountain Psychiatry & Counseling
INTERMOUNTAIN HEALTHCARE
11.2016 - 03.2019
- Created business case, designed, developed, and successfully completed project for new position, Psychometrist, within Mental Health Department for the organization. Provided cost-benefit analysis, proved need for position, and obtained local Management support to submit project to Finance, CFO, and other C-Level Executives for final approval and budgeting.
- Audited all department billing charges to ensure timely submission to insurance. Notified Billing of all outstanding and pending insurance claims requiring attention. Escalated complex issues through management.
- Prepared and processed all patient PHI Release of Information (ROI) medical record forms and abided by all HIPPA guidelines to provide 100% patient confidentiality. Addressed patient questions, provided financial counseling, discussed patient rights and responsibilities, legal consent guidelines.
- Consulted and collaborated with clinic Care Manager to refer and assist patient(s) with information and resources for financial assistance, housing, support groups, and other outside services. Facilitated contact with outside resources on patient(s) behalf.
- Assisted patient with scheduling appointments and obtaining all required information for a smooth hand-off.
- Submitted referrals to other specialty providers, built professional relationships with outside provider offices.
Client Relationship/Project Manager
PHASE ONE ENTERPRISES, INC.
10.2014 - 10.2016
- Engaged as trusted advisor/advocate for all clients, providing full support from initial needs analysis, evaluations, budgeting, project management, vendor relations, and recommendations for IT products and services, to implementation, change orders, training, and post-implementation for all clients.
- Developed, prepared, and presented proposals and contracts for client engagement of services, while demonstrating Return on Investment (ROI) for clients, ensuring ongoing company revenue.
- Used DMAIC framework and identified areas for improvement in workflow processes. Defined and established client goals and timelines for project implementation, ensuring smooth adoption of new technologies. Maintained high client retention and satisfaction rate of 90%.
- Managed account escalations/tracked all issues to successful resolution by cross-functionally with engineering, technical support, vendors, and other third parties.
- Managed HR functions, A/R, A/P, Budgeting and Forecasting, created ad-hoc reports
Education
Master’s Degree - Psychology
Pepperdine University
Irvine, CA05.1998
Bachelor’s Degree - Psychology/Sociology
University of Montana-Missoula
Missoula, MT05.1995
Skills
- Strong written and verbal communication
- Patient-provider communication
- Detail-oriented documentation expertise
- Strong attention to detail
- Analytical skills
- Process optimization
- Relationship management
- Advanced problem solving
- Credentialing and compliance management
- Knowledge of private and public health insurance
- Comprehensive revenue cycle management
Certification
Certified Lean Six Sigma Green Belt Healthcare (CLSSGB-HC)
Work Availability
monday
tuesday
wednesday
thursday
friday
saturday
sunday
morning
afternoon
evening
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Timeline
Senior Patient Benefit Specialist
TEXAS ONCOLOGY – FRISCO WEST
06.2023 - Current
Credentialing & Compliance Manager
LIQUIDAGENTS HEALTHCARE
04.2022 - 06.2024
Senior Patient Benefit Specialist
TEXAS ONCOLOGY – PLANO WEST
05.2021 - 04.2022
Patient Services Specialist III
BAYLOR SCOTT & WHITE – DALLAS DIAGNOSTIC ASSOCIATION
11.2019 - 05.2021
Patient Service Representative – Intermountain Psychiatry & Counseling
INTERMOUNTAIN HEALTHCARE
11.2016 - 03.2019
Client Relationship/Project Manager
PHASE ONE ENTERPRISES, INC.
10.2014 - 10.2016
Master’s Degree - Psychology
Pepperdine University
Bachelor’s Degree - Psychology/Sociology
University of Montana-Missoula
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