Lisa Congleton Email & Phone Number

Philadelphia, PA, US

Plymouth Meeting, PA

• Provides administrative support to the Utilization Review department. This includes intake, eligibility verification of coverage's, pre-certification's of healthcare services.
• Responsible for assisting the Clinical Care Nurse with associated with discharge planning/utilization review functions by way of making phone calls to the facilities/hospitals we service
• Maintains accurate and complete documentation of required information that meets risk management, regulatory, and accreditation requirements
• Receives request, documents, phone calls and creates cases, attach documents and directs calls to the appropriate Clinical Care Nurse, and or Case Manager
• Processes all admissions by completing the documentation process for building all new cases in BabyTrax, adding appropriate codes and diagnoses
• Must maintain all training requirements to maintain compliance of all HIPPA, and PHI regulations, as well as all system updates

330 S Warminster Road, Hatboro PA 19040

• Q/C of pre-certifications already initiated by Doctor’s, Nurse Practitioner’s, clinical representative’s
• Resolve any discrepancies with coding, facilities, of pre-certs
• Obtain Pre-certs for MRI, MRA, PET, and CT
• Complete clinical reviews with Nurse Practitioner’s, Medical Assistant’s, and Doctor’s
• Print and fax over pre-certs to Hospital for filing
• Build relationship with Doctor’s and staff members as well as with Patient’s

2476 Swedesford Road, Malvern PA 19355

• Regional Registration Specialists 5/2014 –Present
• Initiate and or maintain ongoing communication with facilities to ensure timely and accurate receipt of each patient’s insurance coverage information
• Verify patient insurance with payers’ including eligibility and benefits related to outpatient kidney dialysis
• Coordinate and partner closely with Patient Referral Coordinator (PRC) to obtain required documentation for successful patient registration
• Review registration denials received to determine root cause
• Determine Coordination of Benefits as required; maintain current patient account information at all times

2476 E. Swedesford Road, Ste 150 Malvern PA 19355

• Identify trends and perform root cause analysis on unpaid and underpaid claims.
• Research, appeal, and resolve claim rejections, underpayment, and denials with appropriate insurance payer.
• Develop and maintain positive working relationships with clinical personnel, teammates, and insurance representatives.
• Data entry of medical billing using web based tools.

2476 E. Swedesford Road, Ste 150 Malvern PA 19355

• Assign and process action tickets from claims correction database
• Review tickets for accuracy and print supporting documentation as necessary
• Update database to verify request are completed
• Re-apply payments to appropriate insurance and /or claims
• Run Late Charge Reports
• Address outliers for weekly billing, monthly billing.

• Performed audits to ensure the proper set up of all pertinent information regarding home purchases, refinance and mortgage compliance while also performing adverse action on applications
• Directed escalated issues to appropriate departments
• Identified and assisted customers with their needs for refinancing and or general servicing assistance
• Updated customers account regarding refinancing and or purchasing data in mortgage files on behalf of Loan Processor

• Compiled and reviewed reports on mortgaged portfolios’ concerning late charges, suspense funds, reserve requests, and short receivables to keep borrowers/investors informed and updated on any outstanding items that.
• Monitored any collateral that was inspected and received a less than satisfactory inspection
• Adjusted receivables, Billing Statements, and loan records
• Posted updates to loan records concerning Principal Advances and Principal Curtailments, payoff requests, reserve requests for disbursements, and lease reviews at customer(s) or investor(s) requests
• Applied payments to mortgage accounts regarding Principal & Interest, Tax, Insurance, and Reserve(s) constants
• Researched unidentified funds and prepared default packages

• Updated department boarding manual regarding policy and procedures
• Performed training of loans with boarders and new department hires
• Motivated employees to ensure the success of meeting department goals
• Processed and boarded complex deals
• Assisted with correcting receivable errors on loans
• Communicated with staff member’s concerning new boarding guidelines and or procedures

• Reviewed all loans for accuracy and adherence to mortgage guidelines and pull out pertinent information for data entry of all newly originated GMACCM Loans and or Acquisitions
• Updated Access database and additional spread sheets to track loans through the boarding process
• Facilitated the initial loading stages of mortgage loans
• Prepare loans for imaging by providing header pages with key loan data and identify library to store loans
• Communicated with loan producers, closing officers, underwriters and client relations managers and legal entities
• Maintained inventory and ordering of department supplies

Bachelor Of Science, Technical Management

Graduated Cum Laude

Associates Of Applied Science, Business Management