Lisa Schweitzer
McFarland,WI
Summary
Purpose-driven professional with a strong commitment to exceptional customer service and impactful decision-making. Recognized as a brand ambassador, consistently representing organizational values in every interaction. Thrives in environments that prioritize continuous learning, employee appreciation, and community engagement.
Overview
24
24
years of professional experience
1
1
Certification
Work History
Provider Engagement Specialist
Quartz Health Solutions, Inc.
Fitchburg, Wisconsin
01.2023 - 04.2026
- Reviewed provider appeal submissions, engaged with providers for additional information, and conveyed decisions within specified deadlines
- Evaluated underutilized providers within provider network and provided recommendations on contract termination or retention
- Represented organization at industry conferences and new territory trade events
- Executed outreach initiatives to increase awareness of health programs and available resources among providers
- Facilitated onboarding for new clinical staff, focusing on engagement protocols and best practices within required timeline for best practice
- Utilized CRM systems to track, communicate, and provide timely responses for customer interactions
- Delivered exceptional customer service, promptly resolving issues to maintain high levels of provider satisfaction
Senior Provider Relations Coordinator
Quartz Health Solutions, Inc.
Fitchburg, Wisconsin
04.2020 - 12.2022
- Processed provider applications to join the network, communicated the decision within the required timeframe, and initiated next steps in contracting process
- Evaluated provider appeals independently and issued responses within regulated timeframe while maintaining communication with providers for additional information as needed
- Directed overhaul of provider application process to enhance electronic population, offer more timely service to provider customers, and diminish risk of errors
- Managed provider databases and maintained accurate records of contractual agreements, contacts, and orientation completion
- Facilitated prompt and effective resolution of provider inquiries and issues
- Spearheaded collaborative workgroup initiative for contract execution and product identification enhancement
Provider Network Development Specialist
Care Wisconsin First Inc.
Madison, Wisconsin
05.2014 - 04.2020
- Analyzed new provider applications for need, credentials, and communicated decision within regulatory timeframe
- Researched and engaged service providers to support frail elder, physically and developmentally disabled individuals
- Represented organization at vendor conferences, provider summits, and industry events
- Identified and addressed gaps in long-term care provider network across multi-county service region in south central Wisconsin
- Facilitated provider and care team trainings in collaboration with Marketing, Dual Advantage, SSI, Family Care, and Family Care Partnership program management
- Resolved issues and encouraged continuous feedback by cultivating relationships with providers
Contracting Specialist
Care Wisconsin First Inc.
Madison, WI
01.2012 - 05.2014
- Negotiated contracts with medical and long-term care providers across multi-county service region in south central Wisconsin to strengthen provider relationships
- Maintained comprehensive records of all contracts, amendments, and delegation agreements
- Supported three expansion contracting initiatives, maintaining robust provider network during transitions
- Documented provider engagement details to improve communication and collaboration
- Ensured that all relevant parties are aware of their respective responsibilities under the terms of each contract
- Advised management on contractual matters such as dispute resolution options and risk mitigation strategies
Provider Services Specialist - Contracting
Care Wisconsin First, Inc.
Madison, WI
08.2010 - 01.2012
- Analyzed member placement requests and accomplished admission agreements within stipulated timeframe determined by urgency and complexity of care
- Encouraged shared communication between Provider Services, Program Staff, and Regional Leadership by organizing monthly status meetings for each county in my service region
- Partnered with internal personnel and insurance broker to construct and execute provider liability insurance protocols, advancing risk management at Care Wisconsin
Credentialing Coordinator
Care Wisconsin First, Inc.
Madison, WI
08.2008 - 08.2010
- Renegotiated a lower rate for Care Wisconsin's credentialing delegation contract with Dean Health Plan, cutting costs by 50%
- Conducted audits of provider files to ensure accuracy and completeness
- Coordinated credentialing processes for healthcare providers and facilities
Quality Assurance Coordinator
Dean Health Plan, Inc.
Madison, WI
05.2007 - 08.2008
- Coordinated timely and accurate completion of practitioner credentialing and recredentialing in compliance with regulatory and NCQA accreditation requirements
- Provided excellent support to practitioners including training, communications, and problem-solving related to credentialing and quality assurance processes
- Investigated customer complaints regarding product quality issues, identified root causes, and developed corrective actions
Credentialing Specialist III
Dean Health Plan, Inc.
Madison, WI
05.2006 - 05.2007
- Successfully demonstrated compliance with NCQA credentialing accreditation standards at on-site audit, resulting in DHP's "Excellent" accreditation renewal
- Processed re-credentialing applications for existing providers according to contractual requirements
- Reviewed and processed credentialing applications to ensure accuracy, completeness, and compliance with all accreditation standards
- Conducted background checks on potential providers utilizing various resources including state licensing boards, OIG and GSA Exclusion List, NPDB
Credentialing Specialist II
Dean Health Plan, Inc.
Madison, WI
05.2002 - 05.2006
- Ensured timely completion of credentialing processes by providing guidance to providers on required documentation
- Developed tracking mechanism for applications distributed to Credentialing Committee members, and audited Credentialing team production and timeliness of completion
- Checked applications for missing information and organized all paperwork
Education
Bachelor of Science - Marketing
Herzing University
Madison, WI12-2022
Associate of Science - Marketing
Madison Area Technical College
Madison, WI05-2001
Skills
- Customer needs analysis
- Regulatory compliance
- Team collaboration
- Relationship management
- Effective communication
- Judgment and decision-making
Certification
- White Belt and Yellow Belt Lean Six Sigma
Timeline
Provider Engagement Specialist
Quartz Health Solutions, Inc.
01.2023 - 04.2026
Senior Provider Relations Coordinator
Quartz Health Solutions, Inc.
04.2020 - 12.2022
Provider Network Development Specialist
Care Wisconsin First Inc.
05.2014 - 04.2020
Contracting Specialist
Care Wisconsin First Inc.
01.2012 - 05.2014
Provider Services Specialist - Contracting
Care Wisconsin First, Inc.
08.2010 - 01.2012
Credentialing Coordinator
Care Wisconsin First, Inc.
08.2008 - 08.2010
Quality Assurance Coordinator
Dean Health Plan, Inc.
05.2007 - 08.2008
Credentialing Specialist III
Dean Health Plan, Inc.
05.2006 - 05.2007
Credentialing Specialist II
Dean Health Plan, Inc.
05.2002 - 05.2006
Bachelor of Science - Marketing
Herzing University
Associate of Science - Marketing
Madison Area Technical College