Lisa M. Krupka

WORK HISTORY

EDUCATION

ABOUT LISA M. KRUPKA

I am a Board Certified general surgeon with more than 20 years of clinical experience. In January 2021, I transitioned to a career at Aetna.Currently, I am part of the SWAT team, reviewing hospital stays and expanding my knowledge of the payer business and its interactions with the delivery of medical care. I began at Aetna in the role of Medical Director in National Medical Policy and Operations. This role allowed me to use my expertise in health care delivery, payment policies and reimbursement and medical reviews and appeals. Other skills that I developed in this role include providing clinical policy input as a subject matter expert in general surgery, vascular surgery and wound care, adjudicating Medicare claims, processing claims in the special investigations unit, processing pre determination requests, participating in peer to peer discussions and training new members of the team. Additionally, I have earned the designation of Fellow, Academy for Healthcare Management Certification and the designation of Health Care Anti Fraud Associate in the American Health Insurance Plans’s education programs.In 2024, I completed the yearlong Executive Leadership Program offered by AHIP and I was promoted to the role of Senior medical director, where I continued to review claims in Medicare, commercial and Medicaid lines of business while also training our new colleagues.