Lisa Schadtler
Fredericksburg,VA
Summary
With a proven track record at Mary Washington Health Care, I excel in Revenue Cycle Management, showcasing expertise in compliance and denials resolution. My adept use of FISS and Palmetto resulted in maintaining Compliance during a 45% audit volume increase and a zero error rate on several CMS topics.
Overview
20
20
years of professional experience
Work History
Senior Specialist Denials
Ensemble Health Partners
11.2024 - Current
- Recruited to Governmental Audits team for leading Revenue Cycle Management experts
Billing Compliance Specialist
Mary Washington Health Care
06.2017 - 11.2024
- Ensured compliance with multiple Governmental Auditors including the CMS MAC and RAC programs, Medicaid (Myers and Stauffer), Livanta QIO and the CERT program
- Direct responsibility for review and submission of medical documentation to both Governmental and Commercial Auditors
- Served as front-line contact for Palmetto reviewers for both ADR and Targeted Probe and Educate audits resulting in zero percent error rate for seven CMS topics
- Coordinated all correspondence between three Nurses, internal Coding Auditor to ensure timely appeal filing
- Reduced instances of non-compliance through meticulous monitoring of internal processes
Denials Specialist
Mary Washington Health Care
04.2012 - 06.2017
- Maintained knowledge of insurance coverage benefit levels, eligibility systems and verification processes.
- Improved claim denial resolution by thoroughly researching and identifying root causes of denials.
- Optimized workflows within the team by assigning tasks based on individual strengths and expertise in particular payers or denial reasons.
- Identified root cause of denials to provide plans for denial resolution.
Collections, Workers Compensation
HCA Parallon
09.2004 - 03.2012
- Responsible for contacting numerous Payors to achieve payment of Workers Compensation claims
- Assigned as primary contact and liasion for resolution of OCWP claims for Portsmouth Naval Shipyard employees
- Interdepartmental coordination of claims and medical documentation
Education
Associate of Arts -
Suffolk County Community College
Selden, NYSkills
- Extensive use of FISS to preview audits and monitor existing claims
- Frequent use of Palmetto and Cotiviti portals to monitor ADR and RAC claims
- Maintained compliance with a 45% increase in audit volume over a one year period
- Achieved zero error rate for six Targeted Probe and Educate topics
- Responsible for cross-training Regulatory staff on audit processes
- Onboarded and trained new Denials Specialist
- Maintain access to multiple Commercial Auditor website to address direct requests from Reviewers
Timeline
Senior Specialist Denials
Ensemble Health Partners
11.2024 - Current
Billing Compliance Specialist
Mary Washington Health Care
06.2017 - 11.2024
Denials Specialist
Mary Washington Health Care
04.2012 - 06.2017
Collections, Workers Compensation
HCA Parallon
09.2004 - 03.2012
Associate of Arts -
Suffolk County Community College
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