Samantha Sowa
Pleasant Prairie,WI
Summary
To continue growing within a progressive organization by leveraging my education, business knowledge, and experience to support organizational goals and innovation.
Overview
13
13
years of professional experience
1
1
Certification
Work History
Business Change Manager - PI Growth
Carelon
Waukesha, Wisconsin
04.2024 - Current
- Supported business change initiatives across the business unit to enhance efficiency.
- Collaborated with management to evaluate operational and project-related challenges.
- Conducted data-driven analyses to uncover additional cost-saving opportunities.
- Facilitated seamless implementation of changes by analyzing existing processes.
- Contributed to enterprise-wide cost savings through targeted process enhancements.
- Leveraged medical policies and clinical guidelines to identify new business leads.
- Assisted the enterprise in achieving cost savings and process improvement goals.
Provider Reimbursement Admin Sr
Carelon
Waukesha, Wisconsin
02.2017 - 04.2024
- Identified trending billing behaviors to generate new leads.
- Developed and maintained concept pipeline for lead generation initiatives.
- Coordinated with multiple teams to implement lead finder tool effectively.
- Assisted and trained team members in best practices and tool usage.
- Facilitated brainstorming sessions to encourage innovative ideas and solutions.
- Conducted comprehensive audits to standardize processes, enhancing departmental accuracy and efficiency.
Epic Professional Billing/SBO principal Trainer
Wheaton Franciscan Healthcare
Glendale, Wisconsin
01.2016 - 02.2017
- Achieved Epic Professional Billing Certification, enhancing revenue cycle expertise.
- Led strategic initiatives as SME during application go-live, ensuring smooth implementation.
- Developed and enforced policies to support application functionality and compliance.
- Addressed application-related concerns, providing effective problem resolution.
- Designed and updated role-based training curricula for billers, coders, charge entry, follow-up, and supervisors.
- Coordinated with managers to schedule essential training courses for staff development.
Coding Supervisor
Wheaton Franciscan Healthcare
West Allis, Wisconsin
03.2014 - 01.2016
- Supervised 23 coding associates across 12 facilities to maintain operational efficiency.
- Led monthly and weekly Coding Preventive Maintenance meetings to address performance concerns.
- Implemented a denial management process that reduced error rates and improved insurance acceptance.
- Documented key processes enhancing accuracy of coding edit functions.
- Created standard operating procedures for associates to align with new insurance guidelines.
- Served as primary North Market trainer for continuing education, new hires, and process updates.
- Conducted performance evaluations and scheduled training sessions to support staff development.
- Performed monthly quality audits to ensure compliance and improve overall standards.
Coding and Compliance Specialist, Cardiology
Wheaton Franciscan Healthcare
Racine, Wisconsin
08.2012 - 03.2014
- Reviewed provider documentation and conducted audits to ensure accurate coding practices.
- Educated co-workers on proper procedure policies for compliance.
- Conducted ICD-10 training sessions to enhance coding accuracy.
- Researched and resolved coding inquiries related to denied claims and edits.
- Managed responsibilities for CPT and ICD-9-CM coding across outpatient and inpatient settings.
- Streamlined processes for handling denied claims and claim edits effectively.
Education
Bachelor of Science - Public Health, Health Administration
Northern Illinois University
Dekalb, IL05.2012
Minor - Business Administration And Management
Northern Illinois University
Dekalb, IL05-2012
Skills
- Knowledge in EPE Database, Reimbursement policies, Lead finder tool, Encoder, SharePoint, Citrix, Snowflake, PICM, InterAct, CCERT, Looker tool, ACR, WGS, GBD Facets, Contraxx, Aspen, Looker, Mars, Pluto Web Tool, Knowledge library, spark
- Experience in using: ICD-9, ICD-10, CPT codes
- Knowledge of Medical terminology, Anatomy, Physiology
- Competency in Microsoft Office (Outlook, Excel, Word, Access, Powerpoint)
Certification
Certified Professional Coder (CPC), American Academy of Professional Coder (AAPC), December 2011
Timeline
Business Change Manager - PI Growth
Carelon
04.2024 - Current
Provider Reimbursement Admin Sr
Carelon
02.2017 - 04.2024
Epic Professional Billing/SBO principal Trainer
Wheaton Franciscan Healthcare
01.2016 - 02.2017
Coding Supervisor
Wheaton Franciscan Healthcare
03.2014 - 01.2016
Coding and Compliance Specialist, Cardiology
Wheaton Franciscan Healthcare
08.2012 - 03.2014
Bachelor of Science - Public Health, Health Administration
Northern Illinois University
Minor - Business Administration And Management
Northern Illinois University