Lisa West
Tonawanda
Summary
Detail-oriented specialist with extensive experience in denial management and claim submission. Skilled in data analysis and maintaining compliance, contributing to improved operational efficiency and accuracy in healthcare billing processes.
Overview
30
30
years of professional experience
1
1
Certification
Work History
Staff Assistant
SUNY – Buffalo State College
Buffalo
10.2019 - Current
- Facilitated scheduling of clients for evaluation and therapy services in Speech-Language-Hearing clinic.
- Managed meeting room reservations to optimize availability.
- Answered phones, routed voicemails, and provided customer service assistance.
- Handled confidential information with discretion and integrity.
- Maintained electronic and manual filing systems for efficient record-keeping.
- Generated purchase orders for staff-approved items in a timely manner.
- Coordinated administrative tasks across various departments to support faculty and staff.
- Assisted clinical staff and students, enhancing operational workflow.
Provisional Caseworker
Erie County Department of Social Services
Buffalo
04.2019 - 10.2019
- Conducted thorough investigations into child abuse and neglect allegations.
- Prepared detailed case reports documenting findings and recommendations.
- Interviewed children, families, and witnesses to gather relevant information.
- Assessed safety risks to determine appropriate protective measures for children.
- Maintained accurate records in compliance with state regulations and policies.
- Investigated each child's living environment to determine whether home was safe or presented risks.
Billing Analyst
Community Health Center of Buffalo
Buffalo
02.2017 - 04.2019
- Analyzed billing data to ensure accuracy and compliance with regulations.
- Reviewed patient accounts for discrepancies and initiated corrections.
- Maintained up-to-date knowledge of healthcare billing regulations and policies.
- Resolved patient inquiries regarding bills and account balances promptly.
- Managed revenue cycle process from point of prior authorizations to payment receipt.
- Assisted in the preparation of monthly financial statements.
- Provided customer service support to patients regarding billing inquiries.
Insurance Reimbursement Specialist
Ensemble Health Partner
Huntersville
10.2014 - 04.2015
- Maintained work queue daily to ensure timely follow up
- Researched account specifics to follow up appropriately
- Contacted insurance payers via telephone on aged/delayed claims for resolution
- Filed appeals to insurance companies on unresolved claims
Client Contract Coordinator/Auditor
Emdeon/Chapin Revenue Cycle Management
Tampa
07.2008 - 08.2013
- Analyzed reimbursement claims for accuracy and compliance with regulations.
- Reviewed claims data for accuracy and completeness against applicable service agreements.
- Drafted amendments to existing managed care agreements that addressed changes in the regulatory environment.
- Assisted in audits to ensure adherence to reimbursement guidelines and policies.
- Researched rejections, investigating problems to appeal claims.
- Determined medical necessity, using individual insurance carrier regulations.
- Resolved denied claims by verifying information with providers and payers.
- Reviewed and processed medical, dental and vision claims for accuracy and completeness.
- Analyzed patient accounts to identify discrepancies in billing codes or charges.
- Conducted research on coding requirements for diagnosis, procedures, modifiers.
Lead Insurance Representative
Sheehan Memorial Hospital
Buffalo
10.1995 - 04.2006
- Outpatient Medicare Medical Biller: Submission of electronic and paper claims for inpatient and outpatient hospital and physician services.
- Processing EOBs, filing medical appeals, sending requested medical records, and other related billing duties.
- Processed EOB for secondary payor, or private pay, to patients.
- Collaborated with healthcare providers to ensure accurate billing information.
- Supervisor of the Patient Accounts and Registration Department.
Education
Bachelor in Science - Business Management
Everest University
Tampa, FL07.2013
Associate in Science - Medical Billing & Coding
Everest University
Brandon, FL10.2008
Skills
- ICD10 coding
- Scheduling management
- Records management
- Compliance accuracy
- Data analysis
- E/M coding
- Denial management
- Account receivable management
- Claim submission
- Auditing hospital inpatient/outpatient and facility claims
- Inpatient services
- Outpatient services
- Knowledge of payer contracts
- Payment methodology
- Medicare APC
- Medicare PPS
- Administrative skills
- Accounts payable and receivable
- Customer service
Other Related Employment
- AppleOne Agency/Clinical Support Services, Buffalo, NY, Patient Engagement Specialist, 11/16, 01/17
- Sea Coast Staffing/Sunset Park Baptist Church, Wilmington, NC, Secretary, 01/16, 08/16
- Sherman Memorial Church of God and Christ, Charlotte, NC, Secretary, 11/13, 03/15
- ACSYS Agency, Tampa, FL, Consultant-Collection Project at Lifepath Hospice of Hillsborough County, 04/08, 07/08
- Tampa Women Wellness Center, Tampa, FL, Office Manager, 06/06, 11/07
Certifications And Memberships
- American Academy for Professional Coders, Certified Professional Coder (CPC), 2007 - 2011
- Healthcare Finance Management Association, Certified Revenue Cycle Representative, 2015 - 2016
Certification
- Certified Professional Coder
Timeline
Staff Assistant
SUNY – Buffalo State College
10.2019 - Current
Provisional Caseworker
Erie County Department of Social Services
04.2019 - 10.2019
Billing Analyst
Community Health Center of Buffalo
02.2017 - 04.2019
Insurance Reimbursement Specialist
Ensemble Health Partner
10.2014 - 04.2015
Client Contract Coordinator/Auditor
Emdeon/Chapin Revenue Cycle Management
07.2008 - 08.2013
Lead Insurance Representative
Sheehan Memorial Hospital
10.1995 - 04.2006
Bachelor in Science - Business Management
Everest University
Associate in Science - Medical Billing & Coding
Everest University
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