Monica Y. Lewis
Norfolk
Summary
Dynamic healthcare professional with extensive experience at Virginia Oncology Associates, excelling in insurance authorization and patient advocacy. Proven negotiation skills and adept in EHR system deployment, enhancing operational efficiency. Recognized for establishing streamlined processes that improved patient care and financial outcomes, while fostering strong workplace connections.
Overview
21
21
years of professional experience
1
1
Certification
Work History
Infusion Intake Coordinator
Virginia Oncology Associates
01.2024 - Current
- Monitors the MSI fax folder for incoming referrals.
- Ensures notification to referring office and patient registration in Athena.
- Notify the pharmacist to enter orders for the patient.
- Evaluated orders for coverage criteria, including pertinent labs such as TB and Hep B, and documented findings in EMR.
- Executes necessary applications for reimbursement and liability to achieve eligibility.
- Updated status of registration paperwork, R&L information, and financial assistance notes.
- Flagged infusion patients to notify billing office of MSI participation.
- Recorded authorization and financial assistance status in EMR under Insurance Alert.
- Contacted patients to inform them of copay amounts.
- Executed call reminders a day prior to appointments and recorded details in MSI Communication tool in G2.
- Communicated schedule changes to Pharmacy via email to ensure timely modifications of G2 infusions.
- Emails final patient list and patient calendar to weekend team.
- Transmits notice of infusion completion to referring MD office by fax.
- Maintain updated MSI patient spreadsheet with insurance authorization details.
- Updates referring physician about any clinical challenges encountered during infusion.
Senior Patient Benefits Representative
Virginia Oncology Associates
01.2021 - 01.2024
- Prior to a patient receiving treatment, obtains insurance coverage information and demographics; educates patient on insurance coverage, benefits, co-pays, deductibles, and out-of-pocket expenses.
- Assesses patients' ability to meet expenses and discusses payment arrangements. May educate patients on financial assistance programs as well as identify sources and aid with completing forms.
- Based upon diagnosis, estimated insurance coverage, and financial assistance, completes Patient Cost Estimate form. Completes appropriate reimbursement and liability forms for patient’s review and signature. Forwards appropriate information and forms to the billing office.
- Responsible for obtaining insurance pre-authorization or referral approval codes prior to each treatment.
- Ensures that patient co-pay amount is correctly entered into system (or conveyed)
- Verifies and updates demographics and insurance coverage in computer system according to Standard Operating Procedures (SOPs).
- Stays current on available financial aide. Develops professional relationships with financial aide providers. Networks with financial aide providers to obtain leads to other aide programs.
- Adheres to confidentiality, state, federal, and HIPPA laws and guidelines with regards to patient’s records.
- Maintains updated manuals, logs, forms, and documentation. Performs additional duties as requested.
Senior Clinical Insurance Reviewer
Virginia Oncology Associates
01.2012 - 01.2021
- Reviews, processes, and audits the medical necessity for each patient chemotherapy treatment and documentation of regimen relative to pathway adherence.
- Communicates with nursing and medical staff to inform them of any restrictions or special requirements in accordance with insurance plans.
- Provides prompt feedback to physicians and management regarding pathway documentation issues and payor issues with non-covered chemotherapy drugs.
- Updates coding/payer guidelines for clinical staff.
- Tracks pathways and performs various other business office functions on an as needed basis.
- Obtains insurance authorization and pre-certification specifically for chemotherapy services.
- Works as a patient advocate and functions as a liaison between the patient and payor to answer reimbursement questions and avoid insurance delays.
- Research additional or alternative resources for non-covered chemotherapy services to prevent payment denials.
- Provides a contact list for patient community resources, including special programs, drugs and pharmaceutical supplies, and financial resources.
- Maintains a good working knowledge of chemotherapy authorization requirements for all payors and state and federal regulatory guidelines for coverage and authorization.
- Adheres to confidentiality, state, federal, and HIPPA laws and guidelines with regard to patient records.
Office Manager
Minimally Invasive Surgery Center of Tidewater
01.2010 - 01.2012
- Responsible for establishing the standard operating procedures for a new independent surgical practice.
- Researched, presented, and successfully implemented Athena Health components to employer, which enabled the company the opportunity to attest successfully and achieve meaningful use and P4P incentives.
- Negotiated and updated vital payer contracts with leading regional payers.
- Responsible for complex surgical coding in an ever-changing payer-based market.
- Operational management to include scheduling, payroll, supply, hospital consults, and employee recruitment.
- Represented the company at the annual American College of Surgeons coding conference in Nashville for the last two years and was selected to have my coding comments printed on their site.
Clinical Supervisor/ Medical Assistant
Pulmonary & Critical Care Specialists
01.2007 - 01.2010
- Established a streamlined method for gaining timely insurance authorizations for various procedures.
- Enhanced primary care referral process which directly impacted the return on investment.
- Responsible for training all new hires in all phases of the medical environment. This included MA, Scheduling, and managed care authorizations.
- Effectively managed a schedule of 50-60 patients per day for two providers.
Materials Manager
New Gulf Coast Surgery Center
01.2005 - 01.2007
- Responsible for negotiating contracts with various venders to meet surgical needs.
- Maintained budgets to maximize revenue.
- Implemented electronic scanning system to expedite inventory reconciliation.
- Assisted in integrating a private surgical center with Biloxi Regional Hospital by negotiating a broader Managed Care payer platform.
Education
Associate of Arts Degree -
Mississippi Gulf Coast Community College
01.2001
Skills
- Microsoft Word proficiency
- Excel spreadsheet management
- Presentation design
- EHR system deployment
- Strategic time management
- Fostering workplace connections
- Demonstrated negotiation expertise
- Proficient in implementing Athena solutions
Certification
- Serves on the VOA Inclusion Council as member & Sub-committee Co-Chairman
- American Heart Association CPR & AED Certified
- Continuing Education Credits from American College of Surgeons KZA Coding Conferences, Anthem Courses, Athena Learning Portal Completions.
Timeline
Infusion Intake Coordinator
Virginia Oncology Associates
01.2024 - Current
Senior Patient Benefits Representative
Virginia Oncology Associates
01.2021 - 01.2024
Senior Clinical Insurance Reviewer
Virginia Oncology Associates
01.2012 - 01.2021
Office Manager
Minimally Invasive Surgery Center of Tidewater
01.2010 - 01.2012
Clinical Supervisor/ Medical Assistant
Pulmonary & Critical Care Specialists
01.2007 - 01.2010
Materials Manager
New Gulf Coast Surgery Center
01.2005 - 01.2007
Associate of Arts Degree -
Mississippi Gulf Coast Community College
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