Lisa Eldredge Email & Phone Number

• Gathered data and analyzed business requirements and current processes, researched and developed provider and pricing business configuration and processes, data design.• Facilitated meetings, and trained clients on MetaVance. • Analyzed client system & current processes, worked with IT regarding import & conversion concerns, communicated with all other system areas related to implementation. • Tested system integrity for all system areas, tested system build for provider… Show more • Gathered data and analyzed business requirements and current processes, researched and developed provider and pricing business configuration and processes, data design.• Facilitated meetings, and trained clients on MetaVance. • Analyzed client system & current processes, worked with IT regarding import & conversion concerns, communicated with all other system areas related to implementation. • Tested system integrity for all system areas, tested system build for provider and pricing.• (09/09-12/09) Worked on testing team for newly developed Auto-load Access database: tested integrity, capabilities, designed queries, developed scenarios, advised on usability, and executed automated test scripts. Show less

• Complex contract analysis and configuration in NetworX integrated for hospital, physician, ASC, Behavioral Health and all other ancillary. • Built agreements based on state mandates for Medicare and Medicaid markets.• Developed and executed test scenarios, documented test results, troubleshoot and resolved pricing inconsistencies and claim failures. • Identified process improvement and or enhancement needs, documented and reported system defects.• Communicate with all levels… Show more • Complex contract analysis and configuration in NetworX integrated for hospital, physician, ASC, Behavioral Health and all other ancillary. • Built agreements based on state mandates for Medicare and Medicaid markets.• Developed and executed test scenarios, documented test results, troubleshoot and resolved pricing inconsistencies and claim failures. • Identified process improvement and or enhancement needs, documented and reported system defects.• Communicate with all levels of the company, worked with IT regarding import and conversion and instituting testing databases. Show less

• Configured business rules and contracting for Facets system on a monthly cycle, loaded and updated all facility and physician agreements with pricing rules. Performed duties while maintaining quality standards and target dates.• Managed pricing methodologies for DRG, Case, Per Diem, Fee Schedules, ASC, Physician, Behavioral Health, Ambulance, Therapies, Observation, Anesthesia and all other ancillary providers contracted pricing.• Utilized extracts to load data to Access database and… Show more • Configured business rules and contracting for Facets system on a monthly cycle, loaded and updated all facility and physician agreements with pricing rules. Performed duties while maintaining quality standards and target dates.• Managed pricing methodologies for DRG, Case, Per Diem, Fee Schedules, ASC, Physician, Behavioral Health, Ambulance, Therapies, Observation, Anesthesia and all other ancillary providers contracted pricing.• Utilized extracts to load data to Access database and run scenarios for testing; resolved pricing inconsistencies, claim failures, defects, incorrect builds and testing data errors, and documented test results. • Participated in new product implementation consisting of User Guides and test scenario construction; produced documentation for business users and application build for Facets.• Created PowerPoint presentation to explain new features to business users, and answered questions to obtain their acceptance Show less

• Monitored and maintained department budget with Excel spreadsheets and PeopleSoft. • Developed weekly and monthly dental claim inventory reports for management staff, handle payroll reports for staff of 50+, managed department inventory.• Directed all equipment moves; coordinated with IT staff• Created PowerPoint presentations, organized staff meetings, and wrote agendas and minutes.• Communicated with all department leadership and staff, organized all meetings.• Arranged… Show more • Monitored and maintained department budget with Excel spreadsheets and PeopleSoft. • Developed weekly and monthly dental claim inventory reports for management staff, handle payroll reports for staff of 50+, managed department inventory.• Directed all equipment moves; coordinated with IT staff• Created PowerPoint presentations, organized staff meetings, and wrote agendas and minutes.• Communicated with all department leadership and staff, organized all meetings.• Arranged travel for management and executive staff, and put together educational seminars for internal and external staff and clients.• Generate automobile stipends and expense reports, ordered office supplies, and reconciled the monthly account. Show less

• Interpreted medical records, dictation, hospital reports and other records to input data and create insurance claims and invoices on NexTech system. Proficient CPT-4 and ICD-9 knowledge.• Submitted both electronic and hard copy claims and monitored reports• Complied with private, workers compensation and government insurance program guidelines. • Obtained authorizations and referrals for services.• Recorded payments, filed appeals, ran claim and financial reports and managed… Show more • Interpreted medical records, dictation, hospital reports and other records to input data and create insurance claims and invoices on NexTech system. Proficient CPT-4 and ICD-9 knowledge.• Submitted both electronic and hard copy claims and monitored reports• Complied with private, workers compensation and government insurance program guidelines. • Obtained authorizations and referrals for services.• Recorded payments, filed appeals, ran claim and financial reports and managed account reconciliation. • Arranged travel for management and executive staff, and put together educational seminars for internal and external staff and clients.• Communicated with insurance carriers, workers compensation, government agencies, employers, patients, physicians and staff. Show less

Customer Service Representative (1998-2001)• Quality review of specialty dental claims, membership and provider enrollment, and other correspondence. • One of three team members, who managed the system conversion from Vertex to STAR, wrote new system guides, and corresponding decision documents.• Customer service for membership, groups and providers, handled written and phone inquiry and managed appeals. • Managed monthly premium billing and COBRA accounts.• Complied with… Show more Customer Service Representative (1998-2001)• Quality review of specialty dental claims, membership and provider enrollment, and other correspondence. • One of three team members, who managed the system conversion from Vertex to STAR, wrote new system guides, and corresponding decision documents.• Customer service for membership, groups and providers, handled written and phone inquiry and managed appeals. • Managed monthly premium billing and COBRA accounts.• Complied with private, workers compensation and government insurance program guidelines. • Obtained authorizations and referrals for services.• Provided QA for provider capitation and member eligibility, assured quality standards upheld and recorded. • Trained staff and was acting supervisor on stand-in basis as needed.• Communicated and met with employer group representatives and contracted dentists to resolve issues and provide client satisfaction. Show less

Associates, Health Admin- General

Certification, Medical Coding

Ancitipated graduation 2010

Healthcare Administration

Attended but not graduated. Transfered to Centeral Michigan University, not currently attending.

Certificate, Medical Office Specialist