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
• 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.

• 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
• 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.
• 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
• 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

• 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
• Recorded payments, filed appeals, ran claim and financial reports and managed account reconciliation.

• 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)

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