Lisa Tomlin
Cantrall,IL
Summary
Accomplished Follow-Up Specialist Senior with a proven track record at Memorial Medical Center, showcasing exceptional problem-solving abilities and expertise in insurance regulations. Excelled in high-stress situations, achieving successful appeal outcomes and enhancing patient satisfaction through effective communication and policy analysis. Demonstrated leadership by training new staff and contributing to organizational success with a focus on continuous improvement and compliance.
Overview
35
35
years of professional experience
Work History
Follow-Up Specialist Senior
Memorial Medical Center
06.1998 - Current
- Managed high-stress situations effectively, maintaining professionalism under pressure while resolving disputes or conflicts.
- Actively listened to customers, handled concerns quickly and escalated major issues to supervisor.
- Expanded knowledge on medical terminology and insurance policies through continuous learning initiatives, enhancing accuracy in communication with clients.
- Gathered information, assessed and fulfilled callers' needs and educated on important policies and procedures.
- Delivered exceptional customer service to every customer by leveraging extensive knowledge of products and services and creating welcoming, positive experiences.
- Investigated and resolved accounting, service and delivery concerns.
- Increased efficiency and team productivity by promoting operational best practices.
- Promoted a positive work environment through active participation in team meetings and contributing ideas for organizational success.
- Ensured compliance with HIPAA regulations when handling sensitive patient information, protecting client privacy at all times.
- Managed difficult conversations with compassion and professionalism, helping deescalate tense situations while maintaining a focus on finding resolutions.
- Trained new personnel regarding company operations, policies, insurance contracts and services.
- Cross-trained and provided backup support for organizational leadership.
- Accomplished multiple tasks within established timeframes.
- Managed high-stress situations with professionalism, ensuring that appeals were handled promptly and accurately even under tight deadlines or heavy caseloads.
- Consistently met or exceeded performance metrics, demonstrating a strong understanding of the claims review process and an unwavering commitment to achieving positive results for clients.
- Achieved successful appeal outcomes by meticulously reviewing and analyzing claim denials, identifying errors, and presenting persuasive arguments.
Clerk to Membership Examiner
Blue Cross Blue Shield of Illinois
01.1990 - 06.1998
- Enhanced patient satisfaction by efficiently addressing and resolving healthcare-related inquiries.
- Managed difficult conversations with compassion and professionalism, helping deescalate tense situations while maintaining a focus on finding resolutions.
- Maintained accurate records of customer interactions, ensuring proper documentation within the company''s database.
- Assisted policyholders in understanding their coverage options, guiding them through the claims process stepbystep.
- Managed high-volume caseloads, maintaining organization and attention to detail for each individual case.
- Ensured compliance with state regulations by conducting regular audits of claim files and documentation.
- Examined claims forms and other records to determine insurance coverage.
Education
High School Diploma -
Athens High School
Athens, Il05-1989
Skills
- Verbal and written communication
- Policy analysis
- Insurance regulations
- Claims review
- Problem-solving abilities
- Multitasking Abilities
- Great mathematical skills
- Investigation support
Timeline
Follow-Up Specialist Senior
Memorial Medical Center
06.1998 - Current
Clerk to Membership Examiner
Blue Cross Blue Shield of Illinois
01.1990 - 06.1998
High School Diploma -
Athens High School
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