Hi, I’m
Caren R. Lehe
Shingle Springs,CA
The problem is not to find the answer; it’s to face the answer.
Terence McKenna
Summary
Dynamic, customer centric and results-oriented management professional with over 10 years of expertise in Workers’ Compensation, Operational Leadership, Subject Matter Expert – Health Insurance Claims & Cycle Revenue: ICD Coding, Appeals & Grievances, Medical Billing, Healthcare Administration, Operations Management, CA State Industrial Relations, Human Resource Administration, Project Management, Data Analysis, and Patient Advocacy.
Exceptionally adept in constructing solutions that enhance processes and improve efficiency. Talent for identifying, hiring, and training high caliber personnel. Well-versed in regulatory compliance statutes, medical billing/coding, and collections/claims. Technically sophisticated across multiple industry best standard tools with quick mastery of new information, procedures, policies, and emerging technology. Analytical problem-solver and proactive agent; excellent communicator, engaging presenter, and champion of cross-functional teams. Insurance Claims Processing Referrals & Authorizations Medical Billing & Coding Appeals & Grievances HR Resource Administration Change Management Client Relations Management Conflict Resolution Supervision & Staff Development Corporate Training Initiatives Process Improvements C-Level Collaboration Platform Migration Cross-Functional Team Leadership.
Gifted in working with stressed, confused and upset individuals in need of benefits, information and supportive guidance to navigate our healthcare systems. Effective at operating within federal & state regulations and human resource department guidelines processing telephone calls, emails, letters and in-person requests for assistance.
Overview
13
years of professional experience
Work History
CORVEL CORPORATION, Folsom, CA
Workers' Compensation Claims Assistant
10.2019 - 07.2022
Job overview
- Benefits Compensation Claims & Account Liaison
- Administration of third-party insurance company and government agency Worker's Compensation benefits in fast-paced environment
- Utilized critical thinking, time management, organization and leadership skills in order to observe, develop, prioritize actions, implement and train staff in Claims Assistant roles
- Ensure high volume claims handling and best practices in order to adopt and maintain productive and effective streamline processes
- Client Liaison and designated contact-person for direct handling of employee benefit payment processes and management
- Serve as Quality Assurance Auditor for current database conversion
- Verify collected data is appropriate and accurate
- Report issues to Executive Leadership and Developers
- Assist and support multiple assigned Adjusters, Claims Supervisor, and Dept. Vice President in Case Management, projects and other tasks depending on specific client contracted needs
- Meet client specific deadlines in a timely manner while achieving all desired outcomes per leadership and client expectations
- Adhere to CorVel and State DWC Policy Guidelines
- Process benefit payments for all eligible claims, verify and update information on submitted files and review work processes to determine reimbursement eligibility
- Ensure payments and all DWC notification letters are issued in accordance with State guidelines, company Practices & Procedures
- Accurately maintain Payment Roster, Arrears and Check Register on a continually bi-weekly basis
- Notified insurance agents and accounting departments of policy cancellations and changes
- Checked documentation for accuracy and validity on updated systems
- Prepare insurance claim forms or related documents and reviewed for completeness
- Generated, posted and attached information to claim files
- Process and record new claims upon receipt
- Communicateeffectively with staff members of operations, finance and clinical departments
- Carried out administrative tasks by communicating with clients, distributing mail, and scanning documents
- Maintained confidentiality of patient finances, records, and health statuses
- Communicate directly with Account representatives to ensure proper reporting of claimant’s work status
- Evaluate current workflows; properly communicate potential process improvements in order to streamline daily operation
- Maintain files and documentation as appropriate
- Meet department production and quality standards
- Modified, updated and processed existing policies
HEALTH NET/ CENTENE CORPORATION / Wolborg Michaelson, Sacramento, CA
Claims Analyst
02.2019 - 06.2019
Job overview
- Process pended medical claims, verifying and updating information on submitted claims and reviewing work processes to determine reimbursement eligibility
- Ensure payments and/or denials are made in accordance with company practices and procedures
- Apply policy and provider contract provisions to determine if claim is payable, if additional information is needed, or if claim should be denied
- Processing of claims related to physician and hospital services, coordination of benefits (COB), high dollar, special pricing, refunds and/or adjustments
- Research and determine status of medical related claims
- Review charges, access applications and use payment or denial codes within established department guidelines and standards
- Clarify health insurance coverage for coordination of benefits to process claims
- Maintain records, files, and documentation as appropriate
- Meet department production and quality standards
- Analyzed KPIs and Metrics while processing up to 200 claims per day
- Cleared all back-logged inventory due to fall-out macro error reports in 18 weeks
- Led team of new hires in training and development in crucial roles.
SUTTER HEALTH / AEROTEK, Sacramento, CA
Account Representative II
11.2018 - 01.2019
Job overview
- Deliver superior management of the Financial Services Center – Appeals and Grievances division
- Administer financial management and alignment of all financial processing, including cash transactions, payments, adjustments, manual denials, insufficient funds, and general ledger accounting transactions
- Post all payments and adjustments, balance and reconcile all transactions, and verify coding and forward all issues to the Central Business Office or Denial Management team
- Helmed workflow productivity optimization and resolved issues with cross-functional personnel
- Analyzed KPIs and Metrics while processing up to 200 claims per day
- Cleared all backlogged inventory in 6 weeks
- Led team of new hires in training and development in crucial roles.
BLUE SHIELD OF CALIFORNIA, El Dorado Hills, CA
IFP Billing, Claims – Operations Supervisor
04.2016 - 12.2017
Job overview
- Primary operational leader of the Individual and Family Plans Department
- Assessed existing processes, discovered trends and areas for improvement, and submitted all official reports
- Created process improvements to enhance operational effectiveness and efficiency
- Consistently met or exceeded KPIs in productivity, scheduling adherence, and quality standards
- Provided oversight for the IFP Billing Operations Department and the Financial Services Center
- Mentored 40+ medical billers and elevated their personal and professional growth
- Integrated an entire medical billing team
- Acquired 20+ high caliber talent and coordinated a job fair to perform speed interviews
- Interviewed, hired, and on-boarded all new employees
- Authored a 12-week training curriculum when the training department was short-staffed
- Contributed to policy establishment and alignment of billing/scheduling in partnership with the Department Manager
CVS CAREMARK / CORAM SPECIALTY INFUSION SERVICES, Sacramento, CA
Medicaid Billing Supervisor
02.2016 - 04.2016
Job overview
- Managed operations and personnel oversight of the Medicaid Billing department and the Pharmacy Financial Services Center
- Streamlined claims processing, verifying performance, quality, and operational efficiency
- Aligned all work to internal/external compliance regulations
- Audited workflow, identified underperforming areas, prioritized daily operations, and delegated assignments
- Advanced staffing initiatives through stellar HR interviewing processes
- On-boarded and trained staff
- Coached over 20 personnel and promoted professional and personal development initiatives
- Partnered with the Department Manager to enforce billing and scheduling policies
- Collaborated with cross-functional teams to resolve issues
UC DAVIS HEALTH SYSTEMS, Medical Interpreting Services, Sacramento, CA
Administrative Assistant III – Supervisor
04.2012 - 02.2016
Job overview
- Supervised and optimized interpreter scheduling, time-off requests, and delegated assignments
- Provided exceptional management of accounting, data information, and personnel records
- Performed HR processes such as: interviewing, hiring, onboarding, and evaluating the performance of department personnel
- Ensured accuracy of the MIS database and corresponding interpreter functions
- Problem-solved all potential and real-time issues
- Managed inventory control and general office administrative duties
- Led, coached, and developed 43 personnel
- Administered logistics coordination for scheduling and timekeeping
- Reconciled monthly Sign Language invoices from external contractors for submission to Accounts Payable
- Implemented process improvements that contributed to establishing Medical Interpreting Scheduling
EMPRES HEALTHCARE, Chico, CA
CA Regional Health Information Manager
04.2009 - 04.2012
Job overview
- Directed operational efficiency and effectiveness in the region, reporting directly to the CA Regional Vice President and in collaboration with C-Suite executives
- Drove alignment to all internal/external regulatory compliance standards and optimized operations to achieve corporate target benchmarks
- Tracked and maintained database, ensuring data accuracy and integrity
- Delivered steady management of the mastery registry (admissions/discharges)
- Authenticated certifications for Medicare patients
- Upgraded or transitioned existing systems for documentation
- Provided exemplary oversight of 13 Regional Skilled Rehabilitation Centers, streamlining operations in the Medical Records/Health Information Departments
- Achieved A+ rating, with zero citations in every yearly state survey
- Pinpointed incomplete/inaccurate documentation and reports through comprehensive audits
- Resolved all issues
Education
W.I.S.E. University - Cal , Sacramento, CA
Peer Support Specialist
2021
Walden University , Minneapolis, MN
Bachelor’s from Social Work
2020
Southwest Institute of Healing Arts , Tempe, AZ
Integrated Holistic Practitioner
2019
Southwest Institute of Healing Arts , Tempe, AZ
Certified Life Coach
2019
Southwest Institute of Healing Arts , Tempe, AZ
Certified Clinical Hypnotherapist
2018
UC Davis , Sacramento, CA
Certified Business Writing
2015
UC Davis , Sacramento, CA
Certified Conflict Resolution
2014
Dixie Community College , St. George, UT
GED
1997
Skills
Typing Speed 47 wpm, Data Analysis, Database Integration & Migration, ISO 9001 compliant, MS Teams, EPIC, HRMS Data, SIMS, Work Bright, CareMC, Edge, SFT, Legacy, HCM, STARS, SIMS, Workday, Benefit Solver, People Soft, CSAC, Oracle, Zenifits, SIU Compliance, Research Software, Internet Search, Halogen Talent Space, Just Works, Canvas, Blackboard, Cloud Applications, Clear Company, Optimum HRIS, UAT Testing, Gusto, Pocket Suite, Brass Ring, ePremis, MediAR, Chart Logic, Sevocity, Eclipse, Centricity, Genesis, Workbrain, Kronos Workforce Ready Suite, Time Force, EcoTime, MIS, HomeCarePRN, Workable, SPHR, Pine-Apple HR, MS Outlook, SharePoint, Macintosh, Salesforce, OneNote, QuickBooks, Quicken, Lotus Notes, Adobe Illustrator, Adobe Creative Cloud, Adobe InDesign, Adobe Campaign, WordPerfect, MS Access, MS Publisher, MS Power Point, Works, MS Office Suite, MS Word, MS Excel, OneDrive, Social Media Platforms & Advertising, CMS (Content Management Systems), Analytics, Blogging, CSS, AP Style, Digital Media, SEO, WordPress, Google Suite, Web Page Design, Linux, Java, HTML, OSS, SQL Servers, Unix, XML, Spark, Diagnostics, Configuration, Client Support, End User Support, Backup Management, Client Server Management, Implementation, Installation, ITS (Issue Tracking Systems), System Administration, Tech Support, Troubleshooting, Mind Scope, ATS (Applicant Tracking Systems), Kareo, Humanity (Employee Scheduling Software), ICD-10 Coding, Workers' Compensation Claims
Healthcare Claims, Inbound Phone Calls, Policy and Procedure Management, Mail Processing, Medical Diagnosis, Investigation Documentation, Obtaining Authorizations, Compensation and Benefits
Employee Observations, Call Transfers, Intake Interview, Patient Interviews, Digital Filing, Administrative Support, Clerical Support
Exit Interviews, Quarterly Reviews, Income Statements, Accounts Payable and Accounts Receivable, Proactive Communication, Electronic Filing System, Claims Adjustments, Patient Intakes, Managing Patient Cases, Office Supplies and Inventory, HIPAA Guidelines, Human Resources Department Processes, Workplace Safety, Daily Logs, Training Junior Team Members, Policy Requirements and Eligibility, Recordkeeping Organization, Form Preparation, Disciplinary Procedures
Great Mathematical Skills, Project Requirements, Creative Solutions,
Insurance Terminology, Employee Surveying, Legal Requirements
Customer Satisfaction, Patient Scheduling, Policy Reinstatement Approvals, Excellent Administrative Abilities, Personnel Record Management, Personal Data Evaluation, Handbook Development, Employee Programs, Premium Calculations, Exceptional Recordkeeping Abilities, Job Classification, Data Integrity, Information Assistance
Insurance Coverage Limits, Employee Timesheet Processing, Injury Tracking, Insurance Calculation, Large-Sum Computations, Prior Authorization Processing, Composing Business Correspondence, Cancellation Notifications, Payment and Investigation Escalations, Secure Data Practices, Insurance Plan Verification, Policy Modification
Operational Requirements, Special Projects, Settlement Verification, W-4 Changes, Insurance Industry Experience, Account Management Software, Electronic Authorization Processing, Work Organizing and Prioritizing, Multifactor Analysis, Policy Update Coordination, Claims Preparation, Outpatient Procedures, Case Evaluations, Regulatory Compliance Adherence
Websites
Availability
See my work availability
Not Available
Available
monday
tuesday
wednesday
thursday
friday
saturday
sunday
morning
afternoon
evening
swipe to browse
Timeline
Workers' Compensation Claims Assistant
CORVEL CORPORATION
10.2019 - 07.2022
Claims Analyst
HEALTH NET/ CENTENE CORPORATION / Wolborg Michaelson
02.2019 - 06.2019
Account Representative II
SUTTER HEALTH / AEROTEK
11.2018 - 01.2019
IFP Billing, Claims – Operations Supervisor
BLUE SHIELD OF CALIFORNIA
04.2016 - 12.2017
Medicaid Billing Supervisor
CVS CAREMARK / CORAM SPECIALTY INFUSION SERVICES
02.2016 - 04.2016
Administrative Assistant III – Supervisor
UC DAVIS HEALTH SYSTEMS, Medical Interpreting Services
04.2012 - 02.2016
CA Regional Health Information Manager
EMPRES HEALTHCARE
04.2009 - 04.2012
W.I.S.E. University - Cal
Peer Support Specialist
Walden University
Bachelor’s from Social Work
Southwest Institute of Healing Arts
Integrated Holistic Practitioner
Southwest Institute of Healing Arts
Certified Life Coach
Southwest Institute of Healing Arts
Certified Clinical Hypnotherapist
UC Davis
Certified Business Writing
UC Davis
Certified Conflict Resolution
Dixie Community College
GED
Similar Profiles
Julie BoydJulie Boyd
Sr. Claims Specialist at CorVel CorporationSr. Claims Specialist at CorVel Corporation
Deborah Lynne CampbellDeborah Lynne Campbell
Vice President of Operations MN at CorVel CorporationVice President of Operations MN at CorVel Corporation
Sandra EberlySandra Eberly
Telephonic Case Manager Supervisor - MCSIP Program at CorVel CorporationTelephonic Case Manager Supervisor - MCSIP Program at CorVel Corporation