Lisa Edinger
Cranberry Township
Summary
Highly trained professional with 10+ years and 4 years working remote with a background in customer service, health care claims, health insurance, and medical billing. Known for handling various office tasks with undeniable ease. Seeking to maintain a full-time position that offers professional challenges utilizing interpersonal skills, excellent time management and problem-solving skills.
Overview
7
7
years of professional experience
Work History
Claims Benefit Specialist
Cardinal Health
02.2022 - 01.2024
- Coordinated with contracting department to resolve payer issues.
- Reviewed outstanding requests and redirected workloads to complete projects on time.
- Communicated effectively with staff, including members of operations, finance and clinical departments.
- Acted as subject matter expert, answering internal and external questions and inquiries.
- Devoted special emphasis to punctuality and worked to maintain outstanding attendance record, consistently arriving to work ready to start immediately.
- Applied medical necessity guidelines; determines coverage; verified eligibility; identified discrepancies; and applied all cost containment measures to assist in claim adjudication processes.
- Performed claims re-work calculations.
- Identified and reported possible claims overpayments, underpayments, and irregularities.
- Ensured compliance requirements were met.
- Ensured payments were made in accordance with company practices and procedures.
- Reviews pre-specified claims or claims which exceed specialist adjudication authority or processing expertise.
- Ensures compliance requirements are satisfied, and payments are made in compliance with company practices and procedures.
- Re-works claim payments.
- Determines medical necessity and coverage as per guidelines; verifies eligibility; identifies discrepancies, and applies all cost containment measures to assist in claim adjudication processes.
- Manages and monitors daily workflow and reporting to ensure business objectives are maintained and accurately reported; ensures resources are aligned appropriately across function and/or service center.
- Follows a pattern of operations generally standardized, but frequently includes rules, expectations, and special instructions, which demand close attention to process claims.
- Follows strict federal guidelines and state mandates to make determinations on claims.
Medical Billing and Collections Specialist
Austintown Podiatry Associates
12.2020 - 12.2022
- Identified and resolved patient billing errors or additional information needed via phone
and mail. - Compiled and tracked outstanding balances owed to medical facilities.
- Processed online and paper appeal submissions and refund requests.
- Used data entry skills to accurately document and input statements.
- Processed billing calls and answered questions from patients and third-party carriers.
- Assisted in reconciling deposit and patient collections.
Customer Service Representative
Infocision Managment
09.2016 - 12.2021
- Works collaboratively with team members to complete assigned project and tasks.
- Reviews Pharmacy/Medial claims in accordance with Medicare and Medicaid guidelines.
- Navigates through medical determinations through research of resources including regulatory manuals, computer files, and documentation in accordance with prescribed operational guidelines.
- Generated system data to prepare and submit standard weekly/quarterly/monthly reports.
- Organized and scheduled meetings including equipment and resources.
- Communicated with internal constituents through verbal and written correspondence.
- Maintained department logs, reports, and data entry for functional databases.
- Processed incoming checks for deposit, state assessment, and other miscellaneous payments, and processed transaction in an access database.
- Organized, compiled, researched, and analyzed provider accounts to identify credit balances.
Education
High School Diploma -
Lifelong Learning Choices
Skills
- Documentation abilities
- Reporting skills
- MS Office
- Problem resolution
- Customer Service
- Research
- Filing, sorting, organization
- Compliance Management
- Insurance Claim Forms Review
- Teamwork and Collaboration
- Medical Terminology
- Excellent verbal, communication skills
Timeline
Claims Benefit Specialist
Cardinal Health
02.2022 - 01.2024
Medical Billing and Collections Specialist
Austintown Podiatry Associates
12.2020 - 12.2022
Customer Service Representative
Infocision Managment
09.2016 - 12.2021
High School Diploma -
Lifelong Learning Choices
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