Isaac G. Lipsey Sr.

Tempe, Arizona Cell Phone: 623-***-**** Email:ad026a@r.postjobfree.com

(Texting is available)

Objective:

The next chapter in life to is find employment with a company who will recognize and utilize my educational background, knowledge and desire to succeed.

Core Skills

●10+ Years working in the Administration Division of the Healthcare Industry

●15+ Years of Consumer Customer Support, Data Entry & Handling Patient’s Records

●Proficient with Microsoft Operating Systems (Including Word, Excel, Outlook & PowerPoint)

●Experienced in software such as FACETs, Citrix Receiver, DMS, Hippa Gateway, Tri-wiki & Salesforce

●Knowledge of ICD-9, ICD-10 & CPT Coding

●Trained in Enrolling Customers into new, re-enrolling and making adjustments to existing plans.

●Team Coaching, New Hire Training & Mentoring

●Strong Administration and Clerical background

●Ability to Multi-Task with Multiple Screens, Systems and Applications

●Strong typing and computer skills

●Process and Procedure Implementation knowledge and experience

●Knowledgeable of the RX Claim/DOS System

●Entrepreneur

●Work At Home Experience

●Team Lead, Escalation and Supervisor Training/Support

Exceptional Customer Service Communication

EMPLOYMENT HISTORY

Cigna Healthcare

Grievance Coordinator

September 2022-Present

●100% Remote position

●Gather, analyze and report verbal and written member and provider complaints, grievances.

●Prepare response letters for member and provider complaints.

●Maintain files on individual grievances and coordinate with other departments to resolve complex customer complaints.

●Manage large volumes of documents including copying, faxing and scanning incoming mail.

●Assist with HEDIS production functions including data entry, making calls to customers, provider's offices, and claims research.

Aetna/CVS Health Care

ECA – Encounter Claims Analyst / Team Lead September 2021 – August 2022

●Remote Position as a Claims Analyst

●Research and Resolve Encounter errors

●Review and Adjust complex, sensitive and/or specialized claims in accordance with claim processing guidelines and desktop procedures

●Ensure all compliance requirements are satisfied and that all payments are made against company practices and procedures

●Identify and report possible claim over payments, underpayments and any other irregularities.

●Facilitated Team Meetings, Schedules and adequate coverage

●Maintained individual and Team Goals by driving Monthly KPIs and Metrics

Medix Staffing

Bright Health Care Insurance (Temp Position) Jan. 2021 to June 2021

Enrollment Specialist

●Remote Position

●Assisted Members via Inbound Calls with their enrollment needs

●Troubleshooting Issues with Billing

●Processed Refunds

●Took Payments via credit card

●Maintain required KPI and Quality Assurance expectations

●Experience in Drop Box, Zoom, Remote Desktop, Net Extender, Genelco OH for Billing and Enrollment & EMDI

Global Nephrology, Southwest Kidney Institute Feb. 2020 to July 2020 ** During COVID19, the administrative side of the office was sent home to work remotely. When it was time to return to the office this position was eliminated due to head count reduction that was necessary for space separation when returning to the office. **

Referral Coordinator

●Responsible for contacting primary care physicians and insurance carriers to verify if referrals were needed for patient services

●Developed and Implemented a new process to streamline and efficiently improve the department productivity

●Increased workload and productivity by 60%

●Used a Excel spreadsheet to track and match patient records

●Sending out Fax requests to doctor’s offices to obtain referrals for patients visits

●Made outbound calls to other healthcare facilities requesting referrals if not received

●Data Entry into the Athena software to maintain and update patient records

●Attached referrals to patient’s appointment record for claim adjudication

●Filled in as Standing Supervisors and provided other team members with backing and/or questions

●Verified Insurance Policies and patient benefits

●Worked as a Team Member to insure peak productivity

●Conducted Training and provided mentor guidance for new team members/staff

Temporary Positions/Assignments: June 2019 to February 2020

The temporary positions below were set up and managed by a Staffing Agency.

McKesson

Case Manager

Benefits Investigations

●Verify Insurance eligibility via payer websites, portals and phones

●Recognizing and determining various types of insurance, Commercial, PPO, Medicaid & Medicare and their requirements for each and the current company policy

●Ensure that demographic and other information is correct and accurate in the patient database.

●I have thorough knowledge of ICD 10 and CPT Codes

●Experience in Merck Access program, handling specialty medications like Keytruda and Lucentis

●Making outbound calls to obtain information from the verifying eligibility for medication based on the patent’s insurance information plan

●Obtaining prior authorization for services

●Generating benefits summaries

●Obtaining deductibles and out of pocket information

●Procurement of specialist referrals and verifying PCP (Primary Care Physicians) information

●Checking that Medicare guidelines are being followed with the NCCN (National Comprehensive Cancer Network)

●Trained on various different drugs and related information pertaining to the protocols for that certain drug as it may differ

CVS Specialty Pharmacy

Benefits Verification June 2019 to Sept. 2019

●Verified benefits for adjudication of specialty claims.

●Monitored and Assigned claims via email and fax queues.

●Initiated pre-authorization for members medication

●Assisted Members with financial help for high cost medication.

●Worked solely with insurance companies and doctor's office. Little to no interaction with actual members.

●Daily Quota Requirements: Maintain (touched) 16 - 19 cases and closed 8 daily

Humana, Inc (Call Center Facility) Tempe, AZ

NMI Member (Need More Information Team) (1 Year +) Nov. 2016 to Jan. 2019

●Responsible for managing and processing Front End Appeals

●Collected missing data from medical offices to complete authorizations

●Dealing with HMO’s, PPO’s and Medi-Care

●Mentored new team members

●Organized team meetings

●SME (Subject Matter Expert) Responsibilities included but not limited too organizing team workloads and mentoring new hires first two weeks on the floor

●Joined Humana’s Safety Team as Floor Warden (exit strategies, First Aid, CPR & AED Training

●Lead Team building activities

●Assisted Members with payments via credit card, checks and western union methods

●Proficient Communication and Written Skills required to communicate with

●Quick Learner and ability to adapt to changes and implement new procedures

HCPR (Humana Clinical Pharmacy Review) (1 years)

●Responsible for initiating and completing prior authorizations for non-formulary medications

●Inputting data into systems such as Salesforce,

●Communicating with members via phone and email

●Receive, document and resolve customer inquiries by using established best practices

●Educate and inform customers, providers and employers about Humana’s products and services via phone and email

●Interact with Physician’s office, Members, Long Term Care Facilities and Hospitals

●Prioritize daily tasks in order to maximize time and efficiently maintain all required workload each shift.

●Additional daily duties can include: Process referrals, pre-authorization

●Daily workload consisted of 80 to 100 authorizations

K-Force Oct. 2015 to Oct. 2016

As an employee of K-Force Staffing Agency, I completed two temporary assignments as they are described below:

Trizetto (Call Center Facility)

Claim Processor Feb. 2016 to Oct. 2016

●Responsible for examining and processing claims

●Follow the approval and denial guidelines set forth by the state of New Jersey.

●Additional daily duties can include: Process referrals, pre-authorization, XC Claims, penny logic, ABD claims, warning messages, error codes and COB’s

●Maintain weekly quota of 100+ claims

MedImpact (Call Center Facility) Tempe, AZ

CSR – Pharmacy Benefits Helpdesk Oct. 2015 to Feb. 2016

●Responsible for handling all member calls related to prescriptions and medical plans

●Responsible for working with pharmacy to verify benefits

●Authority to adjudicating member insurance claims

●Answering an Avg of 80-100 call daily

●Communicating with helpdesk and PA desk using task routing

●Set up Premium Payments

PayPal, Inc. (Call Center Facility) Chandler, AZ

Claims and Dispute Processor Jan. 2014 to March 2015

●Responsible for handling all disputes and claims for online purchases

●Authority to awarding or denying specific dollar amount depending on the situation

●Allowed to manage the decision of providing courtesy credit to customers

●Answering an Avg of 50-70 call daily

●Monitor and Process email volume for disputes and claims

●Provide technical support for Customer accounts (password reset, online purchases, etc)

●Set up Payments and verify customer security

●Handle customer bank accounts, credit card and debit card transaction

●Participated as the lead speaker during team stand up meetings

Aerotek/Catamaran (Call Center Facility) Tempe, AZ

Member Service Representative (10 month Assignment) March 2013 to Dec. 2013

●Receive inbound calls for PBM (Pharmacy Benefits Manager)

●Assisted Members with ordering refills

●Troubleshooting for company website

●Data Input into members record

●Call Routing to correct departments

●Logged Customer Complaints

●Utilized the RX Claim/DOS System for all client inquiries

Educational Background : GED 1998 - Some college credit via Mesa Community College

References available upon request

Contact this candidate