Lorena Lipovetsky Email & Phone Number

United States

Scotts Valley, Ca

I ensure the accuracy and completeness of provider dispute case documentation and compliance with regulations and requirements related to the Alliance Provider Dispute Resolution process. I develop and oversee the quality assurance function. I supervise, mentor and train team members. I am grateful to continue to support the mission and vision of Central California Alliance for Health:Our Vision: To be a recognized leader in creating local health care solutions.Our Mission: Accessible, quality health care guided by local innovation.Our Values: Culture: We strive for a respectful, diverse, professional and fun workplace.Customer Service: Our customer's satisfaction is our highest priority.Excellence: We value and continuously improve quality in our services.Innovation: We leverage local talent to create solutions.Integrity: We tell the truth and do what we say we will do.Partnerships: We collaborate with others for strong solutions.Stewardship: We manage responsibly, and earn the trust of partners and regulators.

Scotts Valley, Ca

Scotts Valley, Ca

I support the administration and / or resolution of high complexity cases in support of the Alliance Grievance function.• Work within established guidelines and procedures to resolve all assigned cases using the Alliance complaints and disputes tracking system.• Maintain and measure compliance with regulatory timelines and notification requirements for case resolution. • Electronically house and distribute dispute cases to the appropriate departments within the Alliance.• Research the details and history of a case and create a clear timeline of events.• Communicate, both orally and in writing with Alliance providers when needed.• Update providers regarding the progress of active and open cases.• Request, review, sort and prepare medical records related to denied or modified authorizations for the Alliance Medical Director’s review.• Work with relevant departments to complete all necessary follow-up and research.• Prepare and generate provider dispute acknowledgement and resolution letters.• Thoroughly document clear case notes in the disputes tracking system.• Track receipt and resolution of cases and communicate the resolution to all parties involved.• Receive, document and route Provider Disputes that are of high complexity, such as inpatient hospital disputes regarding Diagnosis Related Grouping (APR DRG), appropriate level of care and other unique disputes involving high reimbursement amounts and inpatient disputes with large quantities of attached medical records.• Act as the lead Grievance Team member to track, route and complete requests.• Prepare and draft summaries of dispute trends and unique cases.

Scotts Valley, California

I supervised the daily activities of the Customer Service Representatives.I developed, implementedand participated in both departmental and cross-departmental projects, work groups and committees. I hired, trained and oversaw the CSRs in their daily operations.I monitoref and evaluated the day-to-day work of the CSRs.I conducted regular one on one staff meetings with the CSRs.I trained new employees and conduct regular in-service training for current staff on how to provide accurate information to customers and the community. I prepared and motivated the CSRs as they implement outreach activities.I responded to non-routine and difficult situations when the CSRs needed assistance.I ran, analyzed and submitted a variety of statistical and call center activity reports on a monthly basis.I provided additional coaching and support to the CSR II staff, including assisting in difficult situations or issues.I participated in continuous quality improvement activities including live call and recorded call monitoring to ensure the accuracy of information and the quality of customer service provided by the CSRs.I provided assistance, as required, to other department Supervisors.

Scotts Valley, California

Under supervision, I represented the Central California Alliance for Health (the Alliance) as the first line of contact for members, providers and community partners. I responded to and resolved customer inquiries and requests through a variety of portals including in-person, phone, e-mail, fax, web, and written correspondence. I assisted members with selecting or changing their Primary Care Provider (PCP). I assisted members with understanding how their health plan works, including providing information on benefits, provider network, how to access care, referrals and authorizations and payment for services. I assisted members and providers with inquiries and resolving problems and concerns relating to eligibility, access to care, utilization of services, coordination of benefits, claims, billing and other issues. I made referrals to other programs and services, as appropriate.I received, documented and resolved member complaints through the Alliance’s grievance process.I coordinated provision of services with other departments and completed appropriate documentation of all contacts.I attended training and performed other related duties or special projects, as assigned.

San Salvador, El Salvador, Central America

Purchasing Manager: I purchased educational materials from vendors in the United States. I was responsible for appropriate, timely payment to these vendors. I coordinated shipment of the materials to El Salvador. I checked each order for accuracy upon receipt and finally delivered materials to the appropriate department. In close communication with the accounting department I submitted reports detailing each purchase and the appropriate budget for the expense, on a weekly basis. I worked closely with auditors to submit further reports about the school's educational materials purchases. Travel Coordinator: I coordinated travel for international teachers from the United States to El Salvador. I coordinated travel, accommodations and transportation for large student groups abroad to attend sports events and educational competitions to various countries. I coordinated all payment of hotels, ground transportation, airfare or bus fare for large groups of school teachers who attended educational conferences in other countries.