Katherine Pedersen Email & Phone Number

Brunswick, Oh, Us

Middleburg Heights, Ohio, United States

• Automate prebilling processes for hospitals and laboratories• Analyze, compile and manage industry standard payer data for workflows• Map 270/271 electronic eligibility payer, plan and type data to internal insurance plan codes as part of Insurance Plan Select, our automated prebilling process for billing claims to the correct payer

Middleburg Heights, Ohio

• Perform ongoing research of payers’ EDI transaction capabilities to maximize use ofelectronic eligibility, claim submission, remit, claim status, etc.• Facilitate client setup for electronic remittance advice and electronic funds transfer.• Create quick reference guides for use of Xpeditor; Quadax’s system for processingelectronic transactions.• Process map current revenue cycle workflows and make adjustments to target turnaroundtimes and worklist triggers.• Research payer medical policies and CPT code reimbursement and communicate toappropriate follow-up staff.• Collaborate with insurance support team regarding insurance plan setup, namingconventions, and insurance data maintenance and cleanup.• Identify system inefficiencies, analyze data, and provide strategic recommendations.• Create and disseminate insurance intelligence guides to aid pre-billing representatives.• Shadow different departments in an attempt to identify opportunities for work flowimprovements.• Host Xpeditor training seminars for staff, and assist and answer any resulting questions intheir day to day use of the system.• Assist production staff to reduce worklist volume on an as-needed basis.

Cleveland/Akron, Ohio Area

• Payer liaison who compiles weekly data into projects for reporting aging balances and identifying trending payer issues and payment inconsistencies. This information is then escalated to senior management and provider specialists for reconciliation.• Collaborates with departments to implement payer specific requirements including but not limited to authorizations, medical records, billing and coding edits.• Facilitate meetings and dialog with team members to outline follow-up activities, identify opportunities and strategies that help create and implement best practices.• Project champion for compiling and disseminating process improvement updates and their implementation.• Point person for assistance with and training for technology upgrades and proper utilization.• Train new employees in accessing, organizing and working PFS reports, usage of Epic, ePremis, payer specific denials, follow-up processes, and application of SOPs. • Experience in denials management for multiple insurance product types including but not limited to government, non-government, contracted and non-contracted payers.• Consistently exceeds 96% productivity and 98% quality assurance.• Proficient in claim reconciliation, billing submission requirements and their edit programs as demonstrated in the follow-up process.• Nominated as a Revenue Cycle Management Star Performer acknowledged by Executive Director of RCM. • Task reassignment to more lucrative contracts after 90 days.• Member of Gallup, team dedicated to increasing employee engagement in work groups.

Cleveland/Akron, Ohio Area

• Developed treatment plans with price breakdowns and reviewed with patients.• Worked with insurance companies to determine patient benefits.• Responsible for managing monthly invoices, claims and predeterminations.• Monitored outstanding balances subject to collection efforts and reported all overdue accounts to the office manager.• Organized and handled weekly management statistics to monitor the company’s progress.• Attended three training seminars at MGE in Florida to expand my knowledge in both the health care industry, and in office environments.

Cleveland/Akron, Ohio Area

• Internally managed resources through all phases of projects from research & design through completion/launch to ensure that projects were completed on schedule.• Created project plans including milestones to effectively monitor each project’s progress, provided clients with project status updates and creatively formulated alternative solutions in order to achieve project milestones when necessary.• Acted as liaison with outside vendors.• Tested, reviewed and routed project deliverables for approval prior to sending to clients.• Aided in estimating project costs that were resource driven; monitored the quoted verse actual time allotted for each resource’s task in an effort to stay within budget.• Facilitated kickoff meetings for milestones of each project.• Documented and obtained client approval on project-related change controls. • Promoted to Project Manager from Production Assistant within three months of hire date.• Provided research assistance to support strategic recommendations discovered during diligence phase.• Assisted with daily production activities, including opening and routing projects and coordinating project assignments with the Production Manager.• Updated website content in content management systems.

Medina, Ohio

• Promoted to Project Coordinator from Sales Assistant within three months of hire date.• Cold called prospective advertisers and followed up on leads to develop new business.• Developed and established long-term relationships with customers and prospects.• Prepared layouts for publications prior to printing; aided with ad changes and ad creation. • Developed strong organizational and communication skills which aided in both day-to-day activities, and in generating sales.

Bsba, Marketing & Sales Management

Activities and Societies: Pi Sigma Epsilon

Diploma, General Studies