Lisa Smith-Tunstall

**** **** **** **** *******, TN 38133 (H) 901-***-**** (C) 901-***-****

adzisc@r.postjobfree.com

Summary of Qualifications

I am a highly qualified and experienced healthcare professional with an extensive background of over 17 (seventeen) years’ experience in: health care administration, operations and procedures, process improvement, managing relationships with various provider types I am very experienced in implementing and monitoring workflow processes. I have vast knowledge of HIPPA, OSHA, JACHO, medical terminology, insurance policies, and extensive know how of CPT and ICD-10 coding techniques.

Professional Experience

*United BioSource Corporation, an Express Scripts Company

Eligibility Specialist

09/2015- 2016: United BioSource Corporation (Express Scripts)

Eligibility Specialist/Referral

Aided Nurses and Doctors for mental health injections, and home care.

Set up shipment and delivery of medication to specified locations.

Utilize and understand provider guidance and eligibility processes, to make necessary updates to various internal systems required for UBC's programs.

Serve as first point of contact for internal clients and members during the enrollment process. Make outbound calls to members to gather Enrollment Data; analyze and process data accordingly. Handle inbound member calls and written correspondence regarding member eligibility. Make independent judgments to respond to complex or critical member issues.

Work collaboratively with Eligibility Systems Analysts, other Eligibility Associates, Eligibility Managers and Account Managers to provide seamless support.

Identify and escalate repetitive questions and /or problems so that corrective action can be pursued and expedited.

Maintain accurate and complete documentation of all contacts. This continuously improves the process and reduces potential for legal concerns or payouts.

Complete other projects and additional duties as assigned.

Customer Accounts and Record Representative

01/ 2008 – 8/ 2014: Memphis Light, Gas and Water (Public Utilities)

Completed quarterly reports and met deadlines.

Created invoices and paid various vendors.

Established schedules for employees to attend classes.

Processed personnel FMLA documents

Performed extensive data entry, including the daily processing of employee hours and payroll with 100% accuracy.

Efficiently answered telephones, took messages, scheduled appointments using One Note

Processed and adjusted customer bills to ensure accuracy.

Effectively created and implemented spreadsheets to promote organized tracking of daily, employee logs

Completed paperwork for court documents in accordance with court subpoenas.

Reviewed and filed customer complaints.

Successfully created budget billing protocol for the customers

Contributed to the decrease in employee absences by eighteen percent, with the use of the employee incentive plan within my department.

Medical Scheduler and Coder

12/ 2007 - 4/ 2005: Office Team (Employment Agency)

(Scheduled and confirmed patient diagnostic appointments, surgeries, and medical consultations)

Coding Charts for billing

Billed patient insurance.

P-Card reconciliation

Compiled and recorded medical charts, reports, and correspondence, electronically.

Arranged transportation for special needs patients.

Answered telephone calls in a professional manner and directed calls to appropriate staff.

Received and routed messages and documents, such as laboratory results, to designated staff.

Pleasantly greeted visitors, ascertained purpose of visit, and directed them to appropriate staff.

Interviewed patients to complete documents, case histories, and forms such as intake and insurance forms.

Performed on-site audits of provider offices to ensure health plan requirements are met as far as accessibility, privacy and record keeping

Facilitated research and resolution of provider billing discrepancies and disputes.

Medical Office Administrator

03/2004 - 12/2005 UAHC (TN Care)

Provide internal support for state clinics.

Support installation of new software releases.

Ensure shot records were completed and charted.

Provide ongoing support to clinics for well-checks.

Perform adhoc queries via ACCESS daily or as requested.

Performed administrative duties i.e., setting appointments, verifying insurance, arranging transportation for well-checks.

Documented parent or guardian data according to state guidelines.

Participated in Joint Application Development (JAD) sessions to ensure departments worked more effectively.

Unit Secretary/Medical Administrator

2/2001-7/2006: Gambro Healthcare

Assigned RN to patients according to physician written orders for dialysis treatment, sometimes via phone with proper PID.

Ordered and ran patient labs, filed insurance claims, processed mileage for patients, and scheduled in-office doctor visits.

Prepared patient disability paperwork.

Scheduled patient appointments with other health care providers

Provided patient transportation.

Performed accurate coding and billing.

Adhered to HIPPA, JACHO and OSHA standards.

Unit Coordinator

04/1996-5/2003: Mid-South Home Health

Assigned CNA and RN to patients.

Actively followed up with physicians to ensure each patient was receiving the appropriate type of care.

Coded patient charts for timely billing according to physician diagnosis

Filed claims with appropriate insurance companies.

Ordered patient labs, filed insurance claims, processed mileage for patients, and scheduled in-office doctor visits.

Performed in-home inspections.

Assessed Quality of Life for each patient; ensured all orders were in place, ranging from wills, to “do not resuscitate.”

Performed accurate coding and billing, including closing out patient charts after death.

Adhered to JACHO and OSHA standards.

Greeted patients pleasantly and asked them to complete necessary forms.

Effectively organized and filed patient medical information.

Arranged transportation through TennCare and ambulance services.

Met with medical staff to process their correspondence, type their reports, and produce their presentations, while adhering to company procedure and safeguarding the confidentiality of data

Accurately coded and billed patient charts according to each insurance companies’ guidelines

United States Army – 1988 to 1995 (Honorably Discharged)

Military Medic

Met with patients daily and processed medical charts.

Assisted with running the sick clinic during early hours.

Secured class VI medication (Lortab, or Hydrocodone), started I.V. bags, administered shots needed.

Scheduled follow-up appointments, and processed paperwork when transferring soldiers to the hospital.

Education:

Medical Coding and Billing, Ultimate Medical Academy, Online

Certificates in Medical Billing, Coding, Microsoft, Administration

EMT Certification, Southwest Community College 1989

Fort Sam Military Medical Academy 1989

High School Diploma, Central High School, Memphis, TN 1987

Skills and Specifications

Advanced skills in MS Word, Outlook, EXCEL, PowerPoint, knowledge of ACCESS

Solid mathematical aptitude

Ability to analyze and document business processes.

Solid background in organizing, facilitating meetings, seminars, webinars.

Process and workflow improvement experience

Contact this candidate