Lisa Sweeden

Process incoming patient referrals for consults or admissions, contacts
patients and family for scheduling, gather patient information for
registration and admission, gather and upload appropriate documents
needed for admissions, contact and works with insurance companies for
benefits verification, maintain referral and admission logs, report on
daily scheduled admissions. Works closely with Hospice Care Consultants
to reduce barriers for patient admissions. Works closely with clinical
liaisons to coordinate admissions for hospital patients.

• Monitored outstanding invoices and performed collections duties.
• Identified, researched, and resolved billing variances to maintain system accuracy and currency.
• Assisted colleagues in resolving complex billing issues, promoting teamwork and knowledge sharing within the department.
• Maximized revenue potential by identifying and resolving under-billed accounts.
• Researched and resolved billing discrepancies to enable accurate billing.
• Ensured compliance with industry regulations by staying up-to-date on changes in billing rules and guidelines.
• Prepared itemized statements, bills, or invoices and recorded amounts due for items purchased or services rendered.
• Worked with multiple departments to check proper billing information.
• Maintained detailed records of each account''s payment history, providing easy access to information for audit and analysis purposes.
• Reduced errors in financial records by conducting regular audits of billed accounts.
• Reconciled accounts receivable to general ledger.
• Utilized various software programs to process customer payments.
• Processed payment via telephone and in person with focus on accuracy and efficiency.
• Assisted in transition to electronic billing, reducing paper waste and improving operational efficiency.
• Organized and detail-oriented with a strong work ethic..Responsible for preparing and submitting claims to Medicare Part B, Major Medical, and Medicaid

.Collaborate with various stakeholders, including LTC facility staff, pharmacy operations staff, prescriber offices, third-party payers, patients, and claim processors.

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Navigate multiple operating systems and web-based programs to handle document retrieval, gather additional information, and see claims through to resolution

• Conducted regular audits of billing records to ensure accuracy and completeness, enhancing overall financial performance for the practice.
• Accurately entered patient demographic and billing information in billing system to enable tracking history and maintain accurate records.
• Entered invoices requiring payment and disbursed amounts via check, electronic transfer or bank draft.
• Reviewed patient diagnosis codes to verify accuracy and completeness.
• Collected payments and applied to patient accounts.
• Delivered timely and accurate charge submissions.
• Posted payments and collections on regular basis.
• Filed and updated patient information and medical records.
• Analyzed complex Explanation of Benefits forms to verify correct billing of insurance carriers.
• Liaised between patients, insurance companies, and billing office.
• Prepared billing statements for patients and verified correct diagnostic coding.
• Communicated with insurance providers to resolve denied claims and resubmitted.
• Implemented quality control measures to identify potential errors before submitting claims, reducing rejections significantly.
• Responsible for abstracting, coding, and sequencing the classification of medical diagnoses and any surgical procedures and treatment modalities on patient records to maximize DRG's/CMG's
• Able to prioritize and use analytical skills
• Knowledge of regulatory standards and compliance requirements

. Research and resolve denials and EOB rejections within ABA billing cycle timeframe.

. Troubleshoot solutions for COB and split bill related issues.

. Prepare and submit claims to Medicaid and various Commercial Insurance via clearinghouse or direct submission weekly.

. Accurately post payments received via mail and/or EFT from Medicaid, Commercial Insurance and clients in a timely manner.

. Research and resolve denials and EOB rejections within standard billing cycle timeframe.

. Work with clients to develop self-pay arrangements and or payment plans.

. Ensure all write-offs are documented and sent to management for approval.

. Prepare and submit all payments and disbursement to the Accounts Payable Dept.

. Assist the credentialing department in obtaining Medical credentialing for newly hired and current

Employed BCBA.

. Reconcile month-end statistical report and submit to CEO.

• Verified insurance of patients to determine eligibility.

. Maintain and report daily research and resolution back to the Provider Relations Coordinator. Coordinate with Manager for claims resolutions with the provider relations team.

Enters charges into system accurately and in accordance with information reflected in clinical documentation.

Process, adjust claim, key member, provider, dental claims accurately and timely following established guidelines for accuracy quality and productivity.

• Served as a mentor to junior examiners, sharing expertise and providing guidance on best practices within the field of claims examination.
• Provided coaching and mentoring to employees.
• Mentored new hires, resulting in stronger staff development and increased productivity.
• Established and maintained quality control standards.
• Conducted regular performance reviews for team members, providing constructive feedback and identifying areas for improvement.
• Researched and resolved billing discrepancies to enable accurate billing.
• Worked with multiple departments to check proper billing information.
• Assisted colleagues in resolving complex billing issues, promoting teamwork and knowledge sharing within the department.
• Reduced errors in financial records by conducting regular audits of billed accounts.

• Developed and maintained positive customer relations and coordinated with team members to properly handle requests and questions.
• Communicated with clients and customers to gather, provide and share updated information on products and services.
• Exceeded performance targets through diligent work ethic and focus on results-driven tasks.
• Learned and followed all organizational policies and procedures to maintain safe and professional working environments.

· Answer multi-line phone in a courteous, friendly and professional manner

· Accurately schedules and coordinate appointments for multiple clinical sites.

· Route complex or clinical issues to the appropriate person/Supervisor

· Work to ensure that scheduled appointments will not interfere

· Review and correct provider assignments to patient accounts.

· Respond to member and practitioner grievances

· Collect all payments upon patients check out and departures.

· Performs various research tasks, compiling information/ sending appropriate information to providers.

· Type correspondence and performed other general office duties and special projects as assigned.

• Researched claims and incident information to deliver solutions and resolve problems.
• Processed and finalized appeals and grievances within agreed-upon turnaround time.
• Contributed to organizational goals by consistently meeting or exceeding established performance metrics related to appeals and grievances management.
• Increased staff efficiency through comprehensive training programs focused on best practices in appeals and grievances processing.
• Provided outreach for additional information for appeals and grievances.
• Remained knowledgeable regarding company policies and procedures and current developments within operational departments.
• Submitted verbal and written notification to members and providers.