LISET LEAL
Las Vegas,NV
Summary
Dynamic Utilization Review Coordinator at Riverside Medical Clinic with a proven track record in billing dispute resolution and effective communication. Expert in insurance verification and HIPAA compliance, I excel in fostering collaboration among healthcare professionals to enhance patient care and achieve optimal outcomes. seasoned retail sales management, customer- oriented, strategic thinking , self- motivated,Passionate about driving efficiency and delivering exceptional service.
Overview
11
11
years of professional experience
1
1
Certification
Work History
Utilization Review Coordinator
Riverside Medical Clinic
Riverside, CA
04.2024 - 04.2025
- Served as a trusted resource for clinical staff seeking guidance on appropriate levels of care, alternate treatment options, or clarification on insurance coverage requirements.
- Evaluated medical necessity criteria using evidence-based guidelines to ensure that services provided were both clinically appropriate and cost effective.
- Provided ongoing education to clinical staff on the importance of proper documentation for optimal reimbursement and compliance with regulations.
- Managed complex cases involving multiple medical conditions, coordinating care among various specialists while adhering to strict timelines for decision making.
- Obtained authorizations from multiple insurance carriers for various levels of care.
- Maintained confidentiality and security of patient data, adhering to all relevant privacy laws and regulations.
- Devise or identify solutions for irregular requests and issues.
- Supported positive working relationships between physicians, nursing staff, and other healthcare professionals through clear communication and collaboration on patient-centered goals.
Patient Engagement
Riverside Medical Clinic
Riverside, CA
12.2022 - 04.2024
- Managed high-stress situations effectively, maintaining professionalism under pressure while resolving disputes or conflicts.
- Resolved customer complaints with empathy, resulting in increased loyalty and repeat business.
- Assisted customers with Spanish-language inquiries in a timely and professional manner.
- Enhanced customer satisfaction by addressing and resolving complex inquiries in both English and Spanish languages.
- Met all call quality standards and daily quotas for first-call resolution.
- Collaborated with other departments as needed to resolve customer issues that required cross-functional support or expertise.
- Managed approximately 100 incoming calls on daily basis.
Retail Store Manager
Joffee Brothers
Riverside , CA
05.2019 - 11.2022
- Conducted regular inventory checks to ensure accuracy of product counts.
- Provided guidance to staff members regarding operational procedures.
- Coordinated with other departments within the organization.
- Managed staffing schedules, interviewed potential employees, and provided training for new hires.
- Established relationships with vendors, suppliers, and other partners.
- Maintained a clean work environment to promote safety standards.
- Increased store sales by cross-selling complementary items.
Receptionist/Accounts Receivable
Talco Plastic Inc.
Corona, CA
07.2018 - 05.2019
- Answer and screen incoming calls from clients addressing inquiries and concerns promptly and professionally.
- Scheduled and confirmed appointments.
- Answered and directed incoming calls using a multi-line telephone system.
- Delivered administrative support to team members by making copies, sending faxes, organizing documents and rearranging schedules.
- Sorted incoming mail and directed to correct personnel each day.
- Entered data in Traverse software to keep records of plastic inventory.
- Screened and verified visitors for identification credentials and purpose of visit to maintain security of personnel and office environment.
- Checked announcements and new policy documents for proper formatting, grammar, Spanish translation and spelling using Microsoft Word.
- Answered phone calls, provided information to callers and connected callers to appropriate people.
- Creating a detailed sales report, maintaining accurate cash receipts, collecting and depositing payments, and billing customers.
Legal Receptionist
Law Office of Michael J. La Cilento
Corona, CA
08.2017 - 05.2018
- Photocopied correspondence, documents and other printed materials.
- Assisted in maintaining department attorney personnel files with utmost confidentiality.
- Acted as liaison between clients, vendors and attorneys.
- Processed and distributed invoices to bill clients.
- Worked successfully with diverse group of coworkers to accomplish goals and address issues related to our products and services.
- Juggled multiple projects and tasks to ensure high quality and timely delivery.
- Demonstrated self-reliance by meeting and exceeding workflow needs.
- Provided excellent service and attention to customers when face-to-face or through phone conversations.
Assistant Manager
Chaya Japanese Grill
Costa Mesa, CA
03.2014 - 05.2016
- Delegated daily tasks to team members to optimize group productivity.
- Mentored staff to enhance skills and achieve daily targets, using hands-on leadership.
- Directed and led employees, supervising activities to drive productivity and efficiency.
- Collaborated with the store manager to develop strategies for achieving sales and profit goals.
- Organized schedules, workflows and shift coverage to meet expected business demands.
- Initiated inventory control measures to manage and replenish stock, maintain cost levels and meet customer demand.
- Implemented training processes for newly hired employees and supervised department managers, shift leads and production personnel.
Education
High School Diploma -
Ramona High School
Riverside06.2013
Skills
- Billing dispute resolution
- Credit and collections
- Multi-line telephone skills
- Cashier
- Inventory management
- Data entry
- HIPAA compliance
- effective communication
- Insurance verification
- CPR/AED
- Medical terminology
- Teamwork
- Collaboration
- Customer service
- Problem solving
- Multitasking
- Reliability
- Spanish
Certification
- AED Certification
- CPR Certification
Timeline
Utilization Review Coordinator
Riverside Medical Clinic
04.2024 - 04.2025
Patient Engagement
Riverside Medical Clinic
12.2022 - 04.2024
Retail Store Manager
Joffee Brothers
05.2019 - 11.2022
Receptionist/Accounts Receivable
Talco Plastic Inc.
07.2018 - 05.2019
Legal Receptionist
Law Office of Michael J. La Cilento
08.2017 - 05.2018
Assistant Manager
Chaya Japanese Grill
03.2014 - 05.2016
High School Diploma -
Ramona High School
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