AMY B. SHERMAN

Assess the data to create evidence-based tactical plans. Consolidate data through mapping, segmentation, and profiling of stakeholders. Optimize reimbursement by ensuring coverage of accounts across territories, reviewing patient benefits, authenticating authorizations, and resolving issues. Render knowledge transfer to internal staff and physician office partners. Delivered outstanding service by conducting comprehensive training and education programs for internal staff and physician office partners, ensuring an elevated level of knowledge and expertise

among team members to meet customer needs effectively. Recognized as a valuable mentor in the onboarding process, successfully guiding and supporting new hires during their initial stages of integration into the organization, contributing to their seamless transition and rapid assimilation into their roles.

· Optimized processes by promptly resolving issues by leveraging strong reimbursement policies and procedures.

· Played an instrumental role in assisting large Integrated Delivery Network (IDN) accounts in becoming early adopters of buy and bill practices, enabling efficient procurement and distribution of products across multiple clinic site locations.

· Developed and implemented comprehensive education programs to equip sites with the necessary knowledge and tools for success, including training on provider portals and process mapping, ensuring smooth operations and streamlined workflows, and enhancing overall efficiency and productivity.

Improved reimbursement processes by establishing seamless communication with key stakeholders as per hospital outpatient locations. Assisted patients in obtaining services by resolving reimbursement issues, handling denials and appeals, and identifying other support programs. Collaborated with quality and compliance teams to develop essential resource tools for field teams, ensuring adherence to regulatory standards and enhancing performance and productivity.

· Earned recognition as a lead trainer based on expertise and exceptional training abilities, effectively imparting knowledge and skills to colleagues.

· Leveraged expertise to facilitate the adoption of buy-and-bill practices across multiple office sites, ensuring the fulfillment of patients' needs. Guided offices through the complexities and obstacles associated with specialty pharmacy, enabling them to navigate challenges successfully.

· Spearheaded training efforts as the lead trainer for national and regional field medical and sales meetings, equipping teams with the necessary knowledge and skills to excel in their roles and achieve outstanding results.

· Demonstrated expertise as a new hire onboarding mentor and trainer, providing valuable guidance and support to newly recruited team members, facilitating seamless integration into the organization, and accelerating their proficiency in their respective roles.

Conducted comprehensive reviews of denial documentation, policies, procedures, and patient benefits to proactively recover and prevent potential revenue loss. Provided oversight to the revenue management staff, ensuring smooth processing while maintaining compliance with organizational guidelines. Leveraged software solutions like EPIC, Microsoft Office Suite, and Navi Net to streamline processing operations. Ensured that clinical documentation supported appropriate professional code assignment by educating physicians and staff on requirements, clarifications, and optimization strategies, resulting in the elimination or prevention of payment issues. Maintained an elevated level of expertise in professional reimbursement standards, including HCPCS, ICD9/10, HIPAA, and medical terminology, enabling accurate and thorough documentation and billing reviews.

· Acknowledged to lead department tasks and consistently recognized for exceptional performance within the GHS revenue cycle for four consecutive months, demonstrating strong leadership and impactful results.

· Enhanced patient access to care by collaborating with Highmark BCBS to implement policy changes that expanded coverage for new diagnosis codes, ensuring patients received necessary medical services.

· Identified and eliminated underutilized codes, optimizing the utilization of resources, and improving efficiency.

· Identified and rectified potential lost revenue by conducting a thorough review of denial documentation, policies, and patient benefits, resulting in the recovery of valuable revenue and the prevention of future losses.

· Served as a mentor during onboarding, playing a pivotal role in guiding and supporting newly recruited team members, facilitating their smooth assimilation into the organization, and accelerating their proficiency in their roles.

Developed and effectively managed a comprehensive curriculum in collaboration with the Department of Education to successfully implement new medical programs, ensuring the delivery of high-quality education to students. Demonstrated expertise in curriculum development by crafting syllabi and selecting educational materials and resources tailored to students pursuing various medical career paths, such as nurses, physician assistants, paramedics, massage therapists, and phlebotomists, equipping them with the necessary knowledge and skills for their respective fields.

· Exhibited leadership as a lead instructor, clinical manager, placement director, and hands-on instructor, overseeing aspects of education, including internship placements, classroom teaching, practicum instruction, tutoring, mentoring, and supporting students throughout their educational journey.

· Pioneered establishing new medical programs within two medical schools and colleges, successfully obtaining certification and accreditation from the Pennsylvania Department of Higher Education, ensuring compliance with rigorous standards, and expanding access to quality medical education.