Lori Rowell
Austin,TX
Summary
Healthcare Insurance Specialist with 20+ years’ experience in Medicaid, Manage Care and Medicare products. To explore new opportunities within Centene, and to expand on the skillset that I have acquired through my experience within the company.
Overview
16
16
years of professional experience
Work History
Claims Liaison II
Centene Corporation-Superior Health Plan
03.2016 - Current
- Responsible for End-to-End management of projects submitted for configuration updates while maintaining quality expectations.
- Claims research using multiple Centene platforms (Amisys, Cenpas, etc.).
- Trouble-shooting certain claims issues such as pricing, system updates resulting in unexpected claims behavior, denial resolution, provider rekeys, encounters, and member eligibility.
- Responding to urgent project requests/inquiries from internal customers.
- Network between other departments for project clarity.
Claims Liaison/Provider Relations Specialist
Centene, Superior Health Services
04.2008 - 03.2016
- Researched provider billing and payment issues to final resolution
- Coordinated with other internal departments to ensure proper set up and processing of claim projects
- Provided claim expertise and education to internal and external customers
- Analyzed the Trial Balance reports for trends in claim payment errors and denial codes for four major service delivery areas
- Forwarded results to Management and Provider Relations Team for provider education
- Performed processing of claims for provider projects and adjudicated claims for Senior Management as needed
Volunteer
SafePlace
05.2010 - 05.2012
- Assisted with special events and programs.
- Participated in volunteer orientations and training sessions to learn about organizational changes and mission updates.
- Guided troubled individuals to tools and resources necessary for healing.
Education
High School Diploma -
John Glenn High School
Bay City, MISkills
- Project Management (small scale)
- Microsoft Excel (Vlookups, formulas)
- Claims research and analysis using multiple Centene platforms (Amisys, Cenpas, etc)
- Assisted in onboard training for new Claims Liaisons
- Peer support/Mentoring for project development, reviews, and auditing
- Excellent Customer service
Timeline
Claims Liaison II
Centene Corporation-Superior Health Plan
03.2016 - Current
Volunteer
SafePlace
05.2010 - 05.2012
Claims Liaison/Provider Relations Specialist
Centene, Superior Health Services
04.2008 - 03.2016
High School Diploma -
John Glenn High School
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