Sheri Thomas Email & Phone Number

United States

Follow up on insurance denials and aged claims providing information requested by government and commercial payers to ensure accurate billing information is submitted within timely guidelines. Write and submit appeals with supporting documents to resolve payer denials. Correct and resubmit claims as needed per coding review. Adjust denials as appropriate. Work Contested holds bi-weekly to update registration and resolve other customer service issues as requested by the patients and clinics. Answer and complete all insurance correspondence daily, providing documentation and documenting accounts accordingly. Work retro adjudication work queues on a rotating schedule to identify and correct registration errors. Identify denial patterns for potential process improvement.

Kirkland, Washington, United States

Correct claims based on internal audits, denials, complaints, and rebill using payor approved process. Follow up on denials of corrected claims working closely with coding, Clinic management and department management to resolve claims. Investigating denials to determine appropriate action and provide resolutions. Determine need for appeal and send individualized appeal letter and monitor for follow up resolution. Adjust denied charges as appropriate. Work accounts that meet denial management criteria that have potential financial impact such as authorization, bundling issues, and medical necessity. Identify denial patterns for potential process improvement.

Seattle, Washington, United States

Refund Specialist –Central Business OfficeEnsuring patient satisfaction through timely and effective processing of refund requests. Responding to communication from third party payors with requests for refunds; reviewing, auditing, and processing accounts in credit balance modules identifying accounts for which a refund is due; effectively processing refund requests; submitting notification to payors regarding claims payment issues as needed; trace errors, record adjustments to proper accounts, and determine the appropriate destination for refunds due; resubmitting claims to government agencies, medical service bureaus, and insurance companies ensuring that accounts are billed appropriately by auditing charges to ensure accurate procedure codes, billing data, and patient information submitted; resolve account discrepancies by auditing account detail; processing void and stale dated patient and insurance refunds. Assisting Cash Application Specialists with payment posting during high impact periods.

Corvallis, Oregon, United States

Claims Audit Analyst – Samaritan Health Plans – All Lines of BusinessResponsible for auditing Physician and Hospital claims and preparing detailed reports of audit findings to ensure claims are processed accurately in accordance with contractual obligations and plan benefit guidelines. Work to identify and develop potential areas for claim audits. Develop procedures and identify process improvement strategies related to the claims audit program. Responsible for the preparation of all internal and external audits. Prepares special comprehensive audits as requested. Run reports to assist with the auditing of claims as well as creating tools for various projects. Claims Analyst I – Samaritan Choice PlanSpeed production of all clean Primary Care, Specialty and Institutional Claims, identifying problem claims to be forwarded for the proper course of action. .Account Analyst, Electronic Billing / MedicareElectronic billing for Medicare hospital claims, editing claims, correcting errors, and reporting coding issues according to the CCI Initiative. Combining accounts for OPPS/CAH hospitals. Running daily exception reports, reviewing, placing holds, and combining accounts as needed.Client Account AnalystAnalyst for 3 Major affiliated hospitals Client Accounts. Direct client contact for client accounts, processing their monthly statements, doing write offs and making adjustments as necessary. Enter charges for SHS departments. Create reports for clients monthly and process special reports/statements as requested. Electronically transmit data to clients monthly.Entering Hospital room charges for 3 Hospitals daily including late charges within time constraints and maintain a database for statistical and planning uses.Liaison for Patient Financial Services for Hospital documents stored at storage facility requesting backup for analysts and maintaining a current database of all activity.Ordering printed documents for department, working with the Document Center...