Sheila Larson Email and Phone Number

Analysis and direction to team on various health care reform projects, such as 837I/P changes due to 5010 implementation, ICD9 to ICD10 transition, annual Medicare renewal projects, Family Planning and Women's Preventative services co pay suppression. GEM mapping review for new codes introduced with ICD10. Coordination of benefits updates due to new/changed fields on 5010.EDI upgrades on 837/835/277 interfaces. Provider contract updates, including pricing and code updates. Analysis of business needs and how to best meet changing requirements through changes in code and business processes.Analysis of claims processing inconsistencies.Point of contact for offsite business partners. Developed close relationships with specific business areas to exceed the expectations of business in the project life cycle.Concurrent review of new developments specific to health care claims/billing (5010 and ICD10 implementation).Development of formalized documentation explaining both current and new process for user training.Review of member benefit sets and claims to identify issues with claim processing correctly.CICS and COBOL review of code, direction of staff, and troubleshooting issues.Supervise and direct teams of programmers assigned to my projects. Creation of reviews and ongoing training of programmers. Provided training to new employees, mentoring in company guidelines and processes.Testing and QA preparation and documentation.Develop comprehensive Quality Assurance team from ground level. Creation and ongoing development of process improvement, streamlining end to end delivery model, and documentation practices.

First point of contact for health care providers experiencing claim processing issues, electronic file transmission issues, questions on HIPAA protected patient information, and payment information.Analysis of coding discrepancies.Electronic transmission of batch file troubleshooting,Assistance with Remittance Advice review to determine if claims paid according to individual's benefits.Educated providers on self-help options.National Provider ID (NPI) assistance with Registrar, and ensuring correct NPI loaded into proprietary system for prompt claims processing.Claim Recoupment assistance, advising why a claim was recouped and from which member's claim.Provides detailed eligibility and member benefit Information. Noted for accuracy and efficiency. Consistently exceeds quality standards.Effective communicator, resolving issues promptly.

On-going relationship building with established client companies and Third Party Administrators.Requested as Analyst by existing TPA clients for new deployments.Reviewed file layouts for accuracy, including HIPAA and gateway standard layouts. Implemented new business groups on tight time frames, providing analysis and suggestions for improved efficiency for clients. On-going quality assurance reporting for submitted data files and test scenarios.Primary point of contact for technical issues with file, including manual updates for member issues. High level customer service-received awards for excellent customer service.Found effective method to improve the customer service experience while reducing staff hours spent on deployment of foreign clients.Troubleshooting connectivity issues, data transmission issues, user issues.Efficient tracking and continued excellence in meeting high end time matrixes for internal processes.

Manage deployment, maintenance and repair, support and upgrade of desktops, laptops, software, hardware, and operating systems for multiple local and remote computer systems. Support, monitor, test, and troubleshoot hardware and software problems pertaining to the local area network, virtual private network, and remote connectivity. Configure and maintain routers, firewalls, switches, and hubs including hardware and firmware updates. Web page development, design, and maintenance. Design and instruct computer related workshops/seminars for program staff and participants. Maintain inventory and repair history of all computers and peripheral devices. Analyze and report on required data sets and associated reports. Develop and maintain computer system documentation. Develop and maintain databases specific to company needs.