Glynis Saganitso
Underpayment Specialist
Buckeye,AZ
Summary
Ability to process paperwork across the spectrum of basic and complex issues. Motivated to work under pressure and detail oriented. Resourceful Specialist offering expertise in problem-solving, data analysis and customer service. Adept at quickly learning new technologies and processes for driving success. Proven track record of successfully managing multiple projects and developing innovative solutions.
Overview
23
23
years of professional experience
Work History
Underpayment Specialist
R1 RCM
09.2019 - Current
- Determining whether Contractual Evaluation Report items represent either contractual or government underpayments, or Pediatrix issues which needs to be corrected
- Working with Patient Accounts and Contracting Department to escalate carrier issues and assist in resolving them; or conflicting information in Master Database
- Coordinate with Management on potential carrier underpayment trends
- Requesting claims adjustments, and filing appeals
- Along with following up with the insurance carriers to status the issues.
Credit Balance Specialist
Pediatrix Medical Group
10.2011 - 09.2019
- Review queues, reports and correspondences to analyze accounts
- Completing documentation package accurately with the required form attached
- Ensure the appropriate actions are established by applying Birthday rule when necessary and contractual payers are discounted correctly
- Reviewing weekly credit reports to ensure they are properly completed and timely.
Underpayment Specialist
Pediatrix Medical Group
03.2007 - 10.2011
- Determining whether Contractual Evaluation Report items represent either contractual or government underpayments, or Pediatrix issues which needs to be corrected
- Working with Patient Accounts and Contracting Department to escalate carrier issues and assist in resolving them; or conflicting information in Master Database
- Coordinate with Management on potential carrier underpayment trends
- Requesting claims adjustments, and filing appeals
- Along with following up with the insurance carriers to status the issues.
Credit Balance Specialist
Pediatrix Medical Group
01.2006 - 02.2007
- Working the BRIO (credit report), and identifying/resolving issues regarding credit issues
- Filing appeals with carrier and following up on their status
- Working with Patient Accounts to resolve carrier issues, and identify credit trends
- Following up with Management on check request.
Associate Team Lead
Affiliated Computer Services
12.2000 - 09.2005
- Distribute and maintain paperwork flow as needed for the team on a daily basis
- Coordinate with Management with complex issues
- Ensure all documents and process flows are kept within the regulations of the Department of Education
- Develop and update programs utilized by refunds, build downs and disbursements.
Education
General Studies -
Phoenix College
Phoenix, AZ 08.1999 - 12.1999
Skills
Quality Assurance
Timeline
Underpayment Specialist
R1 RCM
09.2019 - Current
Credit Balance Specialist
Pediatrix Medical Group
10.2011 - 09.2019
Underpayment Specialist
Pediatrix Medical Group
03.2007 - 10.2011
Credit Balance Specialist
Pediatrix Medical Group
01.2006 - 02.2007
Associate Team Lead
Affiliated Computer Services
12.2000 - 09.2005
General Studies -
Phoenix College
08.1999 - 12.1999