Sandra Burton
Odessa,FL
Summary
With over 20 years of experience in healthcare economics, I have climbed from the ground up, seizing numerous incredible opportunities and forging lasting relationships. At Surgery Partners, I led every aspect of neuromodulation cases, while also managing a successful case management team. My responsibilities included negotiating contracts with vendors, fostering provider relations while educating medical policies and payer contracts, overseeing case reviews and approvals, driving business development, conducting financial analysis, and staying abreast of all technological advancements and state/national policies. My tenure at PainTEQ was brief due to nationwide layoffs, yet it was a remarkable experience working on the vendor side, directly servicing providers and sales representatives. There, I collaborated with payers to update their medical policies, and worked intimately with representatives and physicians to navigate payer contracts, address denials, and facilitate payments. Assisting with reimbursement needs is a role I genuinely relish.
Overview
17
17
years of professional experience
Work History
Reimbursement Manager
PainTEQ
Tampa, FL
11.2023 - 07.2024
- Assisted in developing business plans for new projects by providing relevant economic data and insights.
- Provided economic advice and consultation to organizations.
- Reviewed, audited and evaluated client's accounting practices and activities and guided changes and improvements.
- Conducted research to identify potential medical device solutions that meet customer needs.
- Collaborated with new customers to give details about company offerings.
Regional Director of Operations
Surgery Partners
Tamp, FL
05.2008 - 10.2023
- Managed regional staff, including hiring, training, performance reviews and disciplinary actions.
- Negotiated contracts with vendors for goods or services used by regional operations teams.
- Implemented new technologies and systems to optimize operational efficiencies in the region.
- Developed and implemented strategies to improve operational efficiency across the region.
- Analyzed data to identify areas of improvement in processes or procedures within the region.
- Reviewed financial reports and identified opportunities for cost savings.
- Developed relationships with customers in the region through frequent visits or calls.
- Developed and maintained client relationships to grow business and improve account retention.
- Used excellent verbal skills to engage customers in conversation and effectively determine needs and requirements.
AR Specialist
Florida Orthopaedic Institute
Tamp, FL
02.2007 - 06.2008
- Reviewed patient accounts to ensure accuracy and completeness of information.
- Processed appeals related to denied or rejected claims in a timely manner.
- Identified areas where process improvements can be made within the revenue cycle.
- Researched discrepancies on unpaid invoices and reconciled them.
- Audited payments from third-party payers to ensure accuracy of reimbursement amounts.
- Analyzed claims data to identify trends in denials and rejections.
- Maintained current knowledge of insurance policies, procedures, regulations, and guidelines.
- Advised healthcare providers on best practices for submitting accurate claims for reimbursement.
Education
Certified Market Access Reimbursement Analyst (MARA) - Market Access Reimbursement
MAB Institute - MAB Reimbursement Professionals
Virginia, VA04-2024
Skills
- Revenue Cycle Management
- Field Reimbursement
- Provider Relations/Support
- Vendor Contract Negotiation
- Issue Resolution
- Insurance Verification/Authorization
- Analytics skills
- Claims Management
- Reimbursement management
- Contract Review and Negotiation
- CPT/HCPC, Rev Codes, NCD/LCD, Medical Policies
- Spinal Cord Stimulation: Pain/Urinary-Fecal
- Pain Pumps
- SI Joint Fusions
- HST/NextGen, Tableau, SalesForce
References
- Dr. Michael Esposito 908-303-8044
- Jeff Parks COO Alliance 727-271-4533
- Dr. Gregory Van Dam 561-252-7336
- Dr. Miguel Attias 813-344-9230
- Dr. Michael Creamer 407-468-0379
- Michael Mydra (SVP Reimbursement PainTEQ) 612-963-9352
- Skip Simmons (Sales Rep Nevro) 813-777-8300
- Howard Johnson (SVP Sales Axonix) 239-671-2871
Timeline
Reimbursement Manager
PainTEQ
11.2023 - 07.2024
Regional Director of Operations
Surgery Partners
05.2008 - 10.2023
AR Specialist
Florida Orthopaedic Institute
02.2007 - 06.2008
Certified Market Access Reimbursement Analyst (MARA) - Market Access Reimbursement
MAB Institute - MAB Reimbursement Professionals
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