Lisa Halyard

Phone: 813-***-****(Cell) / 904-***-**** (Home)

Email: adliti@r.postjobfree.com

Career Highlights

Twenty plus years of customer service experiences, ranging from retail to call centers.

I pride myself as a team player and always give a 110% no matter the task or job duties. I’m a

dedicated customer service professional with motivation to maintain customer satisfaction and contribute to the company success. Excellent communicator with 10+ years experience working in a demanding call center environment either in as a customer service professional or in a leadership roles.

Skills:

Computer experience, data entry, various phone systems, window, excel, outlook, 10 key, 835

Remittance, ICD Codes, Medical terminology, RUMBA

Professional Experiences

Aetna-

Title: Sr. Benefit Specialist 2/2018- current

Duties: Process provider request for reconsideration of claims (low level appeals), due to prior processing errors, contract errors and various provider disputes. Via fax, electrical submission, calls and emails. While maintaining daily productions and quality standards for my department.

Aetna –

Title: MSO Sr. Claims Processor 9/2017- 2/2018

Duties: Process Outpatient Medicare/ Medicaid claims, while maintaining daily production quota and monthly quality status.

Aetna (Integrity Staffing)

Title: Small Group Underwriter / Prescreen 9/2016- 8/2017

Duties: Process underwritten quotes by preforming analysis and risk assessment for new business. Assist sales representatives when needed to understand rate calculations and understanding departmental policies. While maintaining daily productions

Southwest Orthopedic Specialist

Title: Patient Accounts Service -03/2016-09/2016

Duties:

Inbound/Outbound patient calls to verify payment posting, set up payment plans, explain patient billing. Report patient information to credit bureaus. Cross-train as A/R Rep. posted payment from Insurance companies (Medical & Auto), research missing payments from insurance co., patients and third parties.

Bluecross Blueshield of Florida

Title: Intake Support Coordinator -10/2015-3/2016

Duties:

Inbound calls rep process providers Pre-certification / Authorization requests, verify status of requests, modifier request. While maintaining daily call production of 70 calls per day with a QA of 98%.

Health Integrated

Title: Clinical Support Associate Team Lead 8/2014- 10/2015

Duties:

Process requests for IP/OP pre-cert/authorization and IP stay states for Medicaid and Medicare.

Inbound calls from providers and members while maintaining a daily production quota. Answer any questions the CSA might have pertaining to processing. Handle escalated calls, work special projects for our Medicaid and Medicare clients. Call monitoring, Fax QA, coaching when needed.

Create excel spreadsheets to track representatives daily production, QA score auto tally, spreadsheet for weekly manager meeting.

Vaco Staffing (Coast Dental/ Smilecare Dental)

Title: Claims Collections 5/2014-8/2014(Contract Assignment)

Duties:

Obtain claim information either via insurance company website and/or outbound calls. Responsible for 10 offices while maintaining daily production quotas. Work closely with office manager to assure claims are paid correctly.

Production spreadsheet(excel) for aged accounts.

AppleOne Staffing (Health Insurance Innovation)

Title: Billing Customer Service 3/2014-5/2014 (Contract Assignment)

Duties:

Inbound calls pertaining to third party billing for insurance policies, over phone payment, retention and cancellation. Work with independent agents and agencies, as well as back up for the claims/ benefit department.

Aerotek Staffing (Carecentrix)

Title: AR Credit Rep,1/2014-3/2014(Contract Assignment )

Duties:

Verify company credits to determine if be applied to a patient account and/or if refunded is needed. Special project process claims for provider reimbursement that were denied for various reason .Verified/Created authorization in Intake98 and applied to claims if applicable for processing. Extensive research to determine why credits/adjustment were made on the claim. Utilize various systems such Unity, Claims 98, Intake98 and Provider

Hiregy Staffing (Wellcare)

Title: Claims Specialist 2/2013-6/2013

Duties:

Process Medicaid/Medicare claims for various plans, while maintaining departmental QA and

production goals.

Integral Quality Care (Medicaid)

Title: Member Service Professional /Senior Member Service (Lead) 2/2010-02/2013

Duties:

Handle inbound /outbound member service calls, educated providers, potential and current members on plan type. Quote and verified plan benefits work closely with the provider services and prior authorization departments to assure member and provider were totally satisfied with service available to them. Assist with pharmacy issues via the Express Script system. Process return mail, manual process PCP assignment when needed, manual mailed out welcome packets and other plan material. Work closely with the enrollment department to assure member information came over correctly on the monthly 835 remit from Medicaid. Also attended outreach events. Cross trained for provider service as a backup representative, give claims status, verified provider contracts. In assist the claims /provider relations department. I access the provider EOP and/ or Member EOB’s for additional information. Create department formal processes/policies (desktops), create training materials and train new hires, also created department work schedules. Monitor calls volume daily to assure phone coverage per

Medicaid guidelines. Facilitate weekly team meetings, biweekly department updates meetings as well as team builders outside of work. Handle escalated issues internal and external. QA representative phone calls provided representative coaching when needed. Coordinate and trained on departmental special projects outside of daily responsibilities. Assist with calls during high call volume.

Transfer state enrollment data to in house excel spreadsheet for monthly eligibility information and system updates, also used spreadsheet for provider capitation reports and PCP assignment.Excel various tables/ charts used for annual state meeting s and audits.

Amerigroup (Medicare)

Title: Member Service Professional /Platinum Service Representative–11/2008-1/2010

Duties:

Inbound customer service give benefits and claim status to members, provider and third party providers. Cross train for provider service, worked the customer service helpdesk (SME), took escalated calls, cross- trained for Long Term Care, quote LTC benefits, back up for sales department, outbound schedule verification, Manager back up in their absences. SME during new hire training classes.

United Health Care (Commercial and Medicare)

Title: Claim Processor/ Issue Resolution Representative 4/2007- 11/2008

Process medical claims while maintaining departmental stats.

Process low level appeals and claim adjustments. Respond to provider, member and third party

written correspondence.

Humana Health Insurance (Medicare Part D)

Title: Enrollment Specialist/ Customer Service Professional 1/2006-1/2007

Duties:

Educate potential member on how to enroll in plan and answer any questions they might have pertaining to the plan Part D plan. Cross trained for member and pharmacy services. Give plan pharmacy benefits, process over the phone payments, made payment arrangements. Process pharmacy overrides when needed. As SME answer representative questions when need, handle escalated calls and assist with training new hires.

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