Lisa M. Beardsley
Virginia Beach,VA
Summary
Resourceful, results-driven team player who strives to ensure quality, efficiency, and effectiveness to meet team, individual and management objectives.
Overview
32
32
years of professional experience
Work History
Appeals & Grievances Coordinator
Sentara Health Plan
06.2017 - Current
- Researches disciplinary and grievance issues and recommends optimal courses of action.
- Analyzes & renders final decisions on appeals & complaints in accordance to procedures regulatory requirements
- Masters understanding of laws, regulations, standards and procedures that guide formal appeal/complaint handling and resolving them in compliance with applicable rules related to procedures and timeframes
- Prepares and maintains departmental reporting and statistical data and analysis
- Represents Sentara Health Plan in Administrative Law Judge Hearings for Maximus External Reviews for Medicare members
- Completed in-depth investigations into issues pertaining to discipline and grievance management and recommended strategies.
- Contributed to development of new policies and procedures aimed at further enhancing effectiveness of the appeals process.
- Conducted regular audits of appeals and grievances files to ensure data integrity and proper documentation standards were met.
- Utilizes critical thinking, conceptual thinking and decision-making skills in preparing analysis and/or reports
- Time management proficiency
- Extensive medical terminology knowledge
- Works successfully with diverse group of coworkers to accomplish goals and address issues related to the Health Plan's products and services
- Prioritizes and organizes tasks to efficiently accomplish service goals
- Demonstrates self-reliance by meeting and exceeding workflow needs
- Demonstrates leadership by making improvements to work processes and helping to train others
- Exceeds customer satisfaction by finding creative solutions to problems.
Clinical Coordinator/Registered Medical Assistant
Pediatric Affiliates of Hampton Roads
01.1992 - 05.2017
- Ensured compliance with regulatory standards and best practices through diligent oversight of clinical procedures, documentation, and staff training.
- Contributed to successful health outcomes by effectively communicating between patients and providers about treatments, medications, or follow-up instructions.
- Kept medical supplies in sufficient stock by monitoring levels and submitting replenishment orders before depleted.
- Assisted physicians with various medical procedures, ensuring accurate results and timely treatment.
- Promoted office efficiency, coordinating charts, completing insurance forms, and helping patients with diverse needs.
- Assessed clinical policies and procedures for compliance with changing regulations.
Education
Certified Professional Medical Coder Certification -
MedCerts
Online07.2024
Associates Degree - Medical Assisting
National Education Center
Norfolk, VA01.1992
High School Diploma - Academic
Booker T. Washington High School
Norfolk, VA06.1990
Skills
- Customer Relations
- Microsoft Word
- Quality Assurance
- Multitasking Abilities
- Research
Timeline
Appeals & Grievances Coordinator
Sentara Health Plan
06.2017 - Current
Clinical Coordinator/Registered Medical Assistant
Pediatric Affiliates of Hampton Roads
01.1992 - 05.2017
Certified Professional Medical Coder Certification -
MedCerts
Associates Degree - Medical Assisting
National Education Center
High School Diploma - Academic
Booker T. Washington High School