Lynn Edwards
Scottdale,PA
Overview
26
26
years of professional experience
Work History
Cash Ancillary Supervisor
CVS Specialty Pharmacy
Monroeville
01.2019 - Current
- Managing a team of tenured colleagues with a focus on Cash Reconciliation
- Key Highlights: Reconciling Bank Records and Correspondence
- Identifying current trends, risks, and potential issues
- Resolving discrepancies and providing recommendations to reduce financial risk
- Oversees payment posting, refund processes, intercompany transfers, and adjustments to manage Accounts Receivables
- Forecasts, monitors, and tracks Cash Flow, evaluating variances
- Developed processes to increase efficiency and effectiveness
- Complete ERA enrollments through EDI Vendor
- Track and monitor requests and issues related to electronic files
- Developed and maintained effective relations with colleagues, at various levels
- Perform monthly quality audits and performance evaluations
- Coach and mentor staff as needed when areas of improvement are identified and recognize strengths and high performance
- Provide development opportunities, training and feedback for new staff and facilitate continued growth for existing staff
- Maintaining current knowledge of the industry including potential risks and challenges
- Adhering to organizations inclusive culture and values
- Facilitating meetings with organizational leaders and coordinating projects.
Specialty Pharmacy Liaison
AmeriasourceBergen
Monroeville
01.2015 - 01.2018
- Instrumental in leading the process flow of the Specialty Pharmacy Data Feeds
- Served as a primary point of contact between Physicians and pharmacies
- Key Highlights: Responsible for maintaining the data integrity of the Data Feeds
- Calling for status of the referrals
- Auditing benefit verification phone calls
- Approving or denying triages before they are submitted to the pharmacy for processing
- Weekly calls with the pharmacies to discuss any issues or concerns regarding the Data Feeds
- Processing incoming enrollment forms.
Data Maintenance Manager
Walgreens Sleep and Respiratory Services
Deerfield
01.2010 - 01.2014
- Fulfilled a critical role ensuring the timely and accurate entry of data relating to healthcare providers, insurance, pricing, inventory, and other material information for this leading provider of comprehensive sleep apnea and home oxygen therapy
- Successfully managed team remotely
- Exercised authority over a team of 6 professionals engaged in the processing of up to 90 data requests each day, supporting a network of 30 branches; introduced unprecedented levels of organization to a database containing 2600 physicians, 859 payers, and 121 price tables to ensure accurate billing
- Key Highlights: Recruited with a mandate to restructure the data maintenance team, introducing formal infrastructure and procedures to capture significant gains in efficiency, productivity, and operational effectiveness
- Created and deployed standardized forms for data collection, increasing consistency across all sites
- Secured a ticketing system to enable improved tracking of information requests, while assuming a lead role in the creation of job aids, forms, pricing tools, and other resources
- Coordinated and led training to ensure proficiency across all processes and procedures by all staff
- Executed operational audits to ensure compliance with all established standards and Best Practices
- Contributed additional service and expertise leading projects for the Intake and Reimbursement teams, resulting in improved compliance with requirements necessary to bill Medicare for therapy services
- Slashed the time required to add and update pricing files from 10 days to 2 days, working collaboratively with the IT department to develop a more efficient process
- Reviewing bad debt adjustments to ensure fee schedules are accurate and comply with the Insurance carriers signed contract
- Developed and implement new procedures to improve quality and quantity of work processed.
Data Maintenance Supervisor
Walgreens Infusion and Respiratory/ Rx Pharmacy
Monroeville
01.2007 - 01.2010
- Served as a trusted advisor and mentor to the Data Maintenance Team, providing guidance and assistance to colleagues with respect to all workflows, processes, and procedures, continued employment after an acquisition of the company by Walgreens
- Effectively managed the creation and revision of pricing, payer, referral, physician, and inventory files, leveraging superior analytical expertise to review contract terms to verify the accuracy of all pricing
- Continually worked to improve compliance, modifying standards, and developing Best Practices aligned with the goals of the department and of the organization at large
- Key Highlights: Delivered a 40% gain in compliant billing through a series of process improvements that improved the accuracy and completeness of the physician database by 75%
- Served as a primary point of contact for newly acquired sites, leading training on standardized forms
- Secured a high level of compliance with all Best Practices through the performance of monthly audits.
Billing/Collections Specialist
RX Pharmacy Infusion
Monroeville
01.2002 - 01.2007
- Directed billing and collections processes for Medicare and Medicaid payers for this provider of healthcare services, continuing employment after an acquisition of the company
- Produced and tracked the progress of Certificates of Medical Necessity, while processing online adjudications of claims covered by Medicare Part D
- Key Highlights: Gained invaluable experience in electronic billing, developing expertise in Express Plus and Promise
- Improved revenue production abilities through the development of a Medicare CMN Manual designed to educate and inform the sales force regarding Certificates of Medical Necessity
- Recognized with the GEM Award for outstanding results in patient interaction and reimbursement.
Billing/Collections Specialist
CVS Health
Monroeville
01.1999 - 01.2002
- Instrumental in leading billing processes for government payers for this specialty pharmacy subsidiary of CVS, a multibillion-dollar retail and health care corporation; verified patient benefits while assuming a lead role in the resolution of unpaid claims and denials
- Addressed a high volume of inbound telephone calls from insurance carriers and patients, exercising the authority to discuss the details of each claim to gain progress in billing disputes
- Key Highlights: Engaged in extensive collections activities to secure outstanding patient balances, following up with insurance companies to secure reimbursement.
Timeline
Cash Ancillary Supervisor
CVS Specialty Pharmacy
01.2019 - Current
Specialty Pharmacy Liaison
AmeriasourceBergen
01.2015 - 01.2018
Data Maintenance Manager
Walgreens Sleep and Respiratory Services
01.2010 - 01.2014
Data Maintenance Supervisor
Walgreens Infusion and Respiratory/ Rx Pharmacy
01.2007 - 01.2010
Billing/Collections Specialist
RX Pharmacy Infusion
01.2002 - 01.2007
Billing/Collections Specialist
CVS Health
01.1999 - 01.2002