Mari Lamb-Skinner
Meridian,ID
Overview
10
10
years of professional experience
Work History
Client Services Analyst I
Gainwell Technologies
06.2025 - Current
- Ensures correct prior authorization/referral form is completed for patient’s plan.
- Reviews medical necessity documents for accurate information to include patient provider identification information, clinic or procedure requested, and appropriate CPT/Diagnosis codes to verify the accuracy and completeness of information submitted by healthcare providers.
- Ensures diagnoses, procedures, and services are correctly documented, in accordance with industry standards and regulatory requirements.
- Validates the appropriateness of prior authorization requests and referrals based on established policies, contracts, and medical guidelines.
- Identifies discrepancies or inconsistencies and appropriately communicate them for further investigation.
- Monitors prior authorization requests and referrals processing activities to ensure adherence to legal and regulatory requirements, such as HIPAA, CMS guidelines, and contractual obligations.
- Updates systems with patient information and actions to ensure timely claims payment.
- Achieves daily, monthly, and quarterly quality and productivity KPIs.
- Secures patient demographics and medical information, ensuring HIPPA compliance.
- Training new employees.
- Making a step-by-step training syllabus.
- Making training material.
- Answering questions on complicated prior authorizations.
- Valid end to end payment processing for all cases per one week payment. Including managing and maintaining accuracy and preventing duplicate transactions.
- Navigated a significant amount of operational challenges, to ensure compatibility while maintaining accuracy and conscience.
- Critical thinking skills to identify potential delays and resolve issues efficiently.
- Strong attention to data quality with a focus on data reconciliation between sources and/or platforms handling prior authorization requests and referral requests (intake), medical claims, member eligibility within a healthcare setting.
Administrative Coordinator
Blue Cross of Idaho
Meridian, ID
11.2024 - 05.2025
- Performs day-to-day administrative and operational support for the function/department assigned.
- Performs administrative tasks, which may include intake, data entry, file management, inventory management, invoices, and/or reporting.
- Provides project coordination and assists with project management.
- Supports internal and external stakeholder relations. Liaisons and coordinates with other departments as required.
- Prepares and maintains operations documents and reports.
- Reviews and research inquiries as needed.
- KPI & SLA Tracking.
- Supported department-wide service delivery through efficient reporting and process tracking.
Provider Claims Coordinator (Team Lead)
Blue Cross of Idaho
Meridian, ID
06.2021 - 11.2024
- Review provider claims to ensure they are processing correctly.
- Determine the need for creating new provider accounts following organizational policies.
- Assign claims to the appropriate provider account.
- Perform provider setup or denial based on claim review outcomes.
- Escalate issues as necessary.
- Respond to inquiries and resolve issues related to provider accounts.
- Interpret and apply business rules, policies, and contracts.
- Meet department metric targets to maintain service levels for providers.
- Led provider services initiatives to ensure compliance and improve provider experience.
- Championed cross-departmental coordination to resolve escalations and streamline credentialing workflows.
- Prepare reports and documentation for audits requested by regulatory bodies.
- Tracked KPIs to ensure alignment with service level agreements (SLAs).
- Assist with credentialing processes.
- Maintain provider credentialing system and communicate with providers regarding status and information.
- Ensure compliance with Company, Federal, and State regulatory requirements.
- Perform quarterly reviews and annual audits.
- Report adverse credentialing actions when necessary.
- Participate in testing new applications (UAT testing) for BCI.
- Operational Process Improvement.
- Training & Onboarding staff.
- Contact providers regarding address, tax ID changes, NPI updates, or other applicable changes.
- Deactivate provider accounts when CMS deactivates the NPI, researching the reason.
- Verify accuracy of EIN or Tax ID information through IRS.gov.
Customer Service Advocate I
Blue Cross of Idaho
Meridian, ID
11.2018 - 07.2021
- Managed inbound calls: Handled a high volume of incoming calls from members and providers, addressing inquiries, resolving issues, and ensuring a positive customer experience.
- Reviewed complex claims: Collaborated with members and providers to analyze intricate claims, identify resolutions, and facilitate timely processing.
- Enrolled members in medical and dental plans: Guided members through the enrollment process, explaining benefits and ensuring accurate plan selection.
- Maintained HIPAA compliance: Adhered to strict privacy guidelines when handling sensitive information.
- Updated member accounts: Regularly updated and maintained accurate member records, ensuring seamless service delivery.
- Documented interactions: Thoroughly recorded all actions taken on member accounts, providing a comprehensive history for future reference.
- Provided face-to-face support: Assisted members in person, addressing their needs and answering questions.
- Collaborated with providers: Worked closely with healthcare providers to obtain necessary information for member services.
Customer Service Advocate (Temporary Position)
Collabera (Blue Cross of Idaho)
Boise, ID
09.2018 - 11.2018
- Managed inbound calls, addressing inquiries and resolving issues promptly.
- Reviewed account information with providers and members, ensuring accurate understanding of benefits.
- Monitored email correspondence regularly to stay responsive.
- Utilized available resources effectively during each call.
- Enrolled members in medical and dental plans.
Operations Supervisor
Staples
Boise, ID
12.2017 - 09.2018
- Managed inventory processes, ensuring accurate tracking and efficient stock management.
- Enforced company policies and procedures to maintain compliance and operational consistency.
- Handled financial transactions, including cash handling and reconciliation.
- Executed closing procedures, securing the premises and preparing for the next business day.
Customer Care Representative
Conduent (Xerox)
Meridian, ID
08.2016 - 01.2018
- Troubleshooting.
- Customer Service.
- Account Management.
- Sales.
- Managed inbound calls.
Timeline
Client Services Analyst I
Gainwell Technologies
06.2025 - Current
Administrative Coordinator
Blue Cross of Idaho
11.2024 - 05.2025
Provider Claims Coordinator (Team Lead)
Blue Cross of Idaho
06.2021 - 11.2024
Customer Service Advocate I
Blue Cross of Idaho
11.2018 - 07.2021
Customer Service Advocate (Temporary Position)
Collabera (Blue Cross of Idaho)
09.2018 - 11.2018
Operations Supervisor
Staples
12.2017 - 09.2018
Customer Care Representative
Conduent (Xerox)
08.2016 - 01.2018