Lisa Skinner
Millington,MD
Summary
I am a Lead Claims Analyst with exemplary skills in leadership, mentorship, and project management. Additionally, I have considerable skills in interpersonal communication and relationship development that have proven beneficial when interacting with all stakeholders. I bring almost 30 years of nursing experience and 15 years of experience in the Medicaid space, combined with superior knowledge of standards of care. I am looking to grow my career within this company and move into another level of management.
Overview
29
29
years of professional experience
1
1
Certification
Work History
Lead Claims Analyst
Qlarant
07.2021 - Current
- Managed high-volume caseloads, prioritizing tasks to ensure timely completion of all medical review investigations.
- Maintained compliance with company policies while managing sensitive client information and investigation documentation.
- Demonstrated a high level of accuracy and attention to detail in conducting medical review for approval or denial decisions.
- Interacted with all stakeholders and associates, which helped cultivate positive working relationships.
- Collaborated with all departments to develop best practices for investigation procedures.
- Mentored all levels of associates, sharing expertise in medical review techniques and fostering professional growth within the department.
- Delivered exceptional customer service to all stakeholders, within and outside the company by communicating important information and patiently listening to issues.
- Participated in interviewing and hiring, as well as assigning and directing work.
Claims Analyst II
Qlarant
09.2010 - 07.2021
- Maintained strict confidentiality with all investigative and medical documentation as per company guidelines.
- Managed caseloads, prioritizing tasks to ensure timely completion of all investigative phases.
- Demonstrated a high level of accuracy and attention to detail in reviewing claim documentation for approval or denial decisions.
- Participated in ongoing training programs to stay current on industry developments and maintain a strong understanding of relevant laws and regulations affecting the claims process.
- Conducted thorough investigations into each claim, gathering relevant data and documentation to support decision-making processes.
Intensive Case Manager
Healthways
01.2006 - 09.2010
- Streamlined internal processes for better efficiency in managing complex caseloads for Beneficiaries in the Medicare program.
- Provided ongoing supervision and training to less experienced case managers, fostering a supportive team environment focused on Beneficiary's success.
- Improved community resource access for beneficiaries of Medicare through effective collaboration with local service providers.
- Secured essential services such as medical care and substance abuse treatment for clients facing barriers due to insurance or financial limitations.
- Collaborated with Beneficiaries and local service providers to ensure timely access to medical care and social supports.
- Navigated complex social service systems on behalf of Beneficiaries, advocating for their needs while securing necessary supports and benefits.
- Served as a liaison between Beneficiaries and local services to ensure continuity of care during crisis situations by coordinating emergency services, assessing risk factors, and creating safety plans for vulnerable adults.
Registered Nurse, Emergency Department
Bayhealth Kent General Hospital
05.1999 - 06.2006
- Demonstrated strong clinical reasoning skills when assessing patients' conditions, initiating appropriate interventions, and escalating concerns to physicians as needed.
- Collaborated with physicians to quickly assess patients and deliver appropriate treatment while managing rapidly changing conditions.
- Improved patient outcomes by consistently providing high-quality emergency care and implementing evidence-based nursing practices.
- Administered medications via oral, IV, and intramuscular injections and monitored responses.
- Enhanced patient satisfaction by delivering compassionate, culturally sensitive care tailored to individual needs and preferences.
- Facilitated smooth transitions of care by effectively communicating pertinent information during hand-offs care and discharge planning.
- Collaborated with interdisciplinary teams to plan and implement patient care strategies.
- Enhanced patient outcomes by delivering prompt and accurate care in life-threatening situations.
Registered Nurse, Hematology/Oncology
Anne Arundel Medical Center
09.1996 - 05.1999
- Assisted in the training and mentorship of new nursing staff members, contributing to a positive work environment and high-quality patient care.
- Utilized critical thinking skills to prioritize nursing interventions based on patients' acuity levels and individual needs.
- Collaborated with interdisciplinary teams to develop comprehensive treatment plans for complex patients with multiple comorbidities.
- Conducted thorough patient assessments to identify changes in condition, promptly notifying physicians and initiating appropriate interventions when necessary.
- Administered medications safely according to established guidelines while closely monitoring for side effects or adverse reactions requiring intervention.
- Enhanced patient satisfaction by providing compassionate, holistic nursing care that addressed physical, emotional, and spiritual needs.
Education
Bachelor of Science - Nursing
East Carolina University
Greenville, NC05-1996
Skills
- Interpersonal and written communication, active listening, and decision making
- Policy interpretation
- Team leadership, coaching, mentoring, and collaboration
- Critical thinking, regulatory compliance, records review
- Microsoft Office Suite
Certification
- Certified Professional Coder
Timeline
Lead Claims Analyst
Qlarant
07.2021 - Current
Claims Analyst II
Qlarant
09.2010 - 07.2021
Intensive Case Manager
Healthways
01.2006 - 09.2010
Registered Nurse, Emergency Department
Bayhealth Kent General Hospital
05.1999 - 06.2006
Registered Nurse, Hematology/Oncology
Anne Arundel Medical Center
09.1996 - 05.1999
Bachelor of Science - Nursing
East Carolina University
Similar Profiles
Deborah HandleyDeborah Handley
IT Technician at QlarantIT Technician at Qlarant
Michelle DeanMichelle Dean
Quality Assurance Reviewer at QlarantQuality Assurance Reviewer at Qlarant
Terri WardTerri Ward
Medical Review Lead, Nurse Auditor, RN, CPC, HCAFA at QlarantMedical Review Lead, Nurse Auditor, RN, CPC, HCAFA at Qlarant
Evan NicholsEvan Nichols
Customer Service Representative at Domino's PizzaCustomer Service Representative at Domino's Pizza
MARK KINGMARK KING
Utility Foreman at SWM SOLUTIONSUtility Foreman at SWM SOLUTIONS