Summary
Overview
Work History
Education
Skills
Skills
Community Involvement
Certification
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Timeline
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Lacie Penny

Columbia,WI

Summary

Goal-driven professional with solid background in providing support to diverse clients. Recognized for effectively addressing client needs and fostering positive outcomes through problem-solving and support. Demonstrated proficiency in active listening and empathetic communication.

Overview

6
6
years of professional experience
1
1
Certification

Work History

Senior Medical Reviewer

BlueCross BlueShield of SC
09.2024 - Current
  • Streamlined medical affairs processes by implementing efficient project management strategies, resulting in improved departmental productivity.
  • Facilitated strong connections between pharmacy teams and medical affairs, promoting collaboration and information sharing across departments.
  • Developed and maintained strong relationships with key opinion leaders to ensure access to the latest medical information and insights.
  • Ensured patient privacy by adhering to HIPAA regulations.

General Manager

Blue Ridge Clay Shop
03.2020 - Current
  • Sold over 5,000 units at markets and online.
  • Managed budget, website, and training of 3 employees.
  • Cultivated relationships with over 2,000 clients, including contract negotiation with vendors to ensure long-term success and loyalty.
  • Evaluated quality problems and identified and resolved issues.
  • Resolved customer complaints quickly while prioritizing satisfaction and loyalty.

Clinic Manager

MainStreet Family Care
10.2021 - 03.2022
  • Developed policies and procedures to ensure quality service delivery
  • Monitored clinic billing, coding, and medical records maintenance
  • Collaborated with 9 physicians and 18 staff members to improve clinical processes and patient outcomes
  • Ensured compliance with regulatory requirements such as HIPAA including regular audits of health record system to ensure compliance
  • Oversaw recruitment of 3 new personnel for the clinic, conducting interviews and making hiring decisions.

Medical Claims Project Manager

Northport Pharmacy
07.2020 - 02.2021
  • Negotiated contracts with over 75 vendors and suppliers based on company objectives and budget constraints
  • Drafted reports summarizing progress made on projects
  • Ensured compliance with applicable laws, regulations, policies and procedures throughout the life cycle of each project (HIPAA, insurance requirements)
  • Designed and developed extensive training materials for the organization
  • Acted as subject matter expert regarding accurate claim adjudication.

Medical Claims Specialist

Babytalk Store
04.2019 - 06.2020
  • Verified patient eligibility for medical claims and determined benefit coverage for over 2,000 patients
  • Submitted and tracked an average of 10 medical claims a day to insurance companies via electronic or paper methods
  • Reviewed denials, rejections, and underpayments from insurance carriers and resolved issues in a timely manner
  • Responded promptly to customer inquiries regarding coverage, claim status, and appeals updates.
  • Provided training for 3 new employees

Education

Master of Science - Health Administration

College of Health Professions, The Medical University of South Carolina
Charleston, SC
12.2023

Bachelor of Science in Commerce and Business Administration - Management (Healthcare Analytics, Human Resources)

Culverhouse College of Business, The University of Alabama
Tuscaloosa, AL
05.2021

Skills

  • Ethics and integrity
  • Customer service
  • Problem-solving
  • Relationship building
  • Insurance verification
  • Interpersonal skills
  • Team collaboration
  • Effective communication

Skills

Problem Solving | Empathy | Active Listening | Communication | Customer Relations  | HIPAA Compliance | Employee Training | Attention to Detail | Problem Resolution  | Medical Claims Submission | Public Health Initiatives 

Community Involvement

  • Sigma Kappa Sorority
  • Harvest Hope Food Bank
  • Unhoused Outreach
  • Tuscaloosa Metro Animal Shelter
  • Beat Auburn Beat Hunger

Certification

  • Six Sigma Yellow Belt Certification - 2024
  • Telehealth Administration Certification - 2023

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Timeline

Senior Medical Reviewer

BlueCross BlueShield of SC
09.2024 - Current

Clinic Manager

MainStreet Family Care
10.2021 - 03.2022

Medical Claims Project Manager

Northport Pharmacy
07.2020 - 02.2021

General Manager

Blue Ridge Clay Shop
03.2020 - Current

Medical Claims Specialist

Babytalk Store
04.2019 - 06.2020

Master of Science - Health Administration

College of Health Professions, The Medical University of South Carolina

Bachelor of Science in Commerce and Business Administration - Management (Healthcare Analytics, Human Resources)

Culverhouse College of Business, The University of Alabama

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Lacie Penny