Compliance & Policy Analyst. Medical Billing Administrative Assistant
Resume:
Lisa-Kay Caswell
**** **** **** ******, *** # ***7, Tucson, AZ 85712
*************@********.****
Professional Summary:
Forty years of work experience including Compliance and Policy Management, Refund and Credit Balance Reconciliation, Medicare, Medicaid Health, and Commercial Health Plans, Grievance and Appeals, Medical/Hospital Administrative/Clerical, Medical Records, Coding and Claims Processing, Insurance Billing, Cashier/Retail and Food Service. Over twenty years of experience with various work-related Committees and Community related fund-raising organizations and events including ECAP (United Way), Community Food Bank, American Red Cross, and Toys for Tots.
Experience:
Tucson Medical Center – Denise Hathaway, VP and TMCH Chief Compliance Officer, 10/02/2023 — present
Compliance & Policy Analyst
Description: Reviewing policies and procedures to ensure compliance with regulatory requirements. Preparing compliance reports. Conducting internal audits. Providing compliance training to employees. Responding to regulatory inquiries or examinations. Analyzing organizational compliance. Conducting risk assessments. Monitoring and reporting on compliance issues and violations. Collaborating with various departments to ensure cohesive compliance efforts. Maintaining and updating compliance documentation. Investigating and resolving compliance-related complaints and incidents.
Tucson Medical Center - Nicole Jackson, Manager Revenue Cycle Mgt, PFS Patient Customer Svc, 06/10/2021 to 09/28/2023
Patient Account Specialist Senior, Refund Specialist
Description: Evaluate and complete insurance refund requests. Review patient overpayments. Assist with credit accounts. Ensure accurate insurance payment evaluations. Ensure Refund requests align with payor contracts.
Tucson Medical Center - Kathy O'Hara, Manager, Patient Financial Services, 01/09/17 to 06/09/2021
Patient Account Specialist
Description: Assisting in filing insurance claims, determining write-offs, and resolving coding issues. Contacting patients and insurance carriers to resolve open balance and account issues. Writing and submitting appeals, answering phone inquiries, and resolving issues affecting timely claim payment. Investigating over-payments and taking appropriate action to resolve. Managing patient files, retaining transcripts, and facilitating prompt payment of claims. Thoroughly understanding patient billing, claims submission, and payer-specific requirements.
Cheyenne Regional Medical Group, 02/23/15 to 12/18/16
Billing Representative, Medicare Follow-up
Description: Assisting in filing insurance claims, determining write-offs, and resolving coding issues. Contacting patients and insurance carriers to resolve open balance and account issues. Writing and submitting appeals, answering phone inquiries, and resolving issues affecting timely claim payment. Investigating over-payments and taking appropriate action to resolve. Managing patient files, retaining transcripts, and facilitating prompt payment of claims. Thoroughly understanding patient billing, claims submission, and payer-specific requirements.
Optum Palliative and Hospice Care (UnitedHealthcare), 04/21/14 to 12/05/14
Senior Patient Intake Coordinator
Description: UnitedHealthcare / Optum Hospice and Palliative Care program closed. Coordinating new intake referrals and Hospice orders. Collecting Data from Referral Sources. Insurance and authorization verification. Gathering medical records for admission process. Coordinating Intake appointment with Hospice RN, Case Management, and Medical Director. Data Entry of records into EMR system. Ordering of DME equipment.
UnitedHealthcare Community Plan, Long Term Care, 09/12/11 to 04/18/14
Department Resource Specialist, BSL
Description: Process Monthly referral and authorization. Assisting Case Managers with filing, follow-up, and documentation processing. Data Entry. Maintaining patient immunization records and other State required test results. Coordinating appointments with Case Managers and Medical Director.
Bridgeway Health Solutions/ Pima Health System Grievance and Appeals Department, 01/01/11 to 09/11/11
Grievance and Appeals Coordinator
Description: Process Monthly referral and authorization. Assisting Case Managers with filing, follow-up, and documentation processing. Data Entry. Maintaining patient immunization records and other State required test results. Coordinating appointments with Case Managers and Medical Director.
Pima County Pima Health System Grievance and Appeals Department, 10/2009 to 12/2010
Administrative Support Specialist Senior – Grievance and Appeals Specialist
Description: Logging and research of Provider Claim Disputes, including Appeal Resolution Letters and requests for State Fair Hearings. Medicaid follow-up billing Preparing reports for Grievance Manager, Corporate Compliance Officer, Deputy Director of PHS and others as directed based on data required by AHCCCS. Data entry and analysis of confidential provider and member information. Recording and transcribing various meetings minutes; general office duties and specialized tasks as assigned.
Pima County Pima Health System Administrative & Personnel Service, 06/2009 to 10/2009
Administrative Support Specialist Senior
Description: Clerical support to Administrative and Personnel Services, Deputy Compliance Officer, Quality Management Manager, Provider Services, and other Management staff as requested, including recording and transcription of meeting minutes, reviewing messages, emails, daily calendars, correspondence, and maintenance of County and PHS Standard and Procedures Manuals. Claims processing, Contracts, Preparing confidential employee annual reviews and performance plans. Other duties as assigned.
Pima County Pima Health System Administrative & Personnel Service, 01/2008 to 06/2009
Administrative Support Specialist Senior – Personnel Director Administrative Assistant
Description: Confidential personnel documentation including employee annual reviews and performance plans. Recording and transcription of meeting minutes, reviewing phone messages, emails, daily calendar, correspondence, and maintenance of County and PHS Standard and Procedures Manuals. Researching employee rights and responsibilities based on the Pima County Merit System.
Pima County Pima Health System Chief Medical Officer (CMO), 02/2006 to 01/2008
Administrative Support Specialist Senior –Administrative Assistant to CMO
Description: Confidential review of medical documentation related to Medical Management and review of Prior Authorization request. Recording and transcription of meeting minutes, reviewing phone messages, emails, daily calendar, and correspondence. Assisting Quality Management Manager with the writing of the yearly Quality Management Plan to AHCCCS. Working closely with all PHS employees to prepare the ACUTE and ALTCS RFPs (Request for Proposal).
Pima County Clerk of the Board, Board of Supervisors, 11/2005 to 02/2006
Administrative Support Specialist
Description: Recording and transcription of Board of Supervisors weekly public meetings. Assembly of weekly agendas and addendums. Assisting the public with request for meeting minutes.
Pima County Health Department Health Records, 09/2002 to 05/2005
Data Entry Specialist
Description: Customer Service. Medical records data entry, archiving records, meeting minutes and office supply orders. Assisting Public Health Nursing with mass immunization clinics.
Pima County Public Health Nursing, 05/2001 to 09/2002
Office Support Level III
Description: Customer Service, Family Planning clinics, Immunization clinics, International Travel Clinics, TB testing, ordering and maintenance of immunizations, medical and office.
Pima County Health Department Health Records, 04/2000 to 09/2002
Office Support Level II
Description: Customer Service. Medical records data entry, archiving records, meeting minutes and office supply orders. Assisting Public Health Nursing with mass immunization clinics.
Education:
Grand Canyon University, BS Public Administration, expected graduation August 2026
University Of Phoenix; Business Administration, 2005
Costal Alabama Community College; Business Administration, 1995
Pima County Community College; Bus Admin, Marketing and Management, 1983 to 1985
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