Summary
Overview
Work History
Education
Skills
Timeline
Generic

Santhary Saing

Beaverton,OR

Summary

Reimbursement Supervisor with proven track record in the support to increase business for OHSU Home Infusion Pharmacy Services with monthly goals met. Excelled in collaborating with healthcare providers to enhance patient care service outside of hospital setting. Successfully transition home infusion workflow from CPR+ to EPIC system. Skilled in provider education and streamlining processes to optimize outcomes.

Overview

17
17
years of professional experience

Work History

Reimbursement Supervisor

OHSU Home Infusion Pharmacy Services
01.2024 - Current
  • I serve as the first line of communication with practices/departments to answer questions, trouble shoot issues and improve processes/workflows now and during the EPIC transition.
  • Responsible for business decisions in the absence of the department-level leadership.
  • Responsibilites includes for the supervision of the Managed Care and/or Insurance Verification/Patient Estimate team within Home Infusion dept. Managed care responsibilities include eligibility and benefit verification, prior authorization and patient estimates.
  • Supervises 8 staff currently and will continue to grow the team. Duties include; leads team by recruiting, training mentoring and managing the workqueues and performance of all direct reports.
  • Continuously sought opportunities for process improvement, implementing changes that led to reduced turnaround times and increased claim approval rates.


PAS Reimbursement Specialist

OHSU Home Infusion Pharmacy
12.2017 - 01.2024
  • Responsible in coordinating prior authorization with multiple health plans, ensuring accurate billing and compliance. To work directly with payers on outstanding claims for reimbursement with the extensive knowledge of third-party processing.
  • To assist in coordination of all home infusion referrals to ensure that all necessary information is received and available to clinicians
  • Implemented and assist in understanding insurance policies on how to bill for home infusion and prescription processing; to interact with other health care team members with a high level of customer service commitment.
  • Assisted management with reviewing the fee schedule to ensure we stay competitive with other home infusion companies, to assist with high dollar claims.

Intake Coordinator

Option Care at Legacy
10.2015 - 12.2017
  • Responsible for performing the appropriate procedures to verify patient eligibility, coordinate benefits, run test claims, and determine patient coverage/responsibility for service, testing and implementations of new plan business for home infusion.
  • Coordinate referrals between different business units, external sources and patients by creating documentations required to service the patient per policy and payer guidelines
  • Determines estimated patient financial responsibility using insurance verification information and payer contracts and/or self-pay guidelines
  • Obtain authorization prior to admitting the patient for all services for any insurance plan that has authorization requirements.
  • Coordinated with finance team to improve billing cycles and cash flow.

Reimbursement Specialist

Walgreens/Option Care at Legacy
11.2008 - 10.2015
  • Managed multiple priorities effectively under high-pressure deadlines without compromising accuracy or quality of work output.
  • Compiled department-specific reports to help senior managers identify trends and improve progress.
  • Knowledgeable of all contracts involve to maintain accurate payments; to analyze accounts receivable spreadsheets to corporate; to update quarterly semiannual analysis reports.
  • Account research on claim denials due to contract issues requires communicating with insurance companies on outstanding claims for correct reimbursement.
  • Contributed knowledge to help improve financial management, billing and tracking systems.

Education

Bachelor of Science - Finance

Portland State Un
Portland, OR
06-1993

Bachelor of Science - Psychology

Portland State University
Portland, OR
06-1993

Skills

  • Leadership skills
  • Managed Care
  • Insurance Verification
  • Analytics skills
  • HIPAA Compliance
  • Issue Resolution
  • Effective customer communication
  • Team assistance and oversight
  • Teamwork and collaboration

Timeline

Reimbursement Supervisor

OHSU Home Infusion Pharmacy Services
01.2024 - Current

PAS Reimbursement Specialist

OHSU Home Infusion Pharmacy
12.2017 - 01.2024

Intake Coordinator

Option Care at Legacy
10.2015 - 12.2017

Reimbursement Specialist

Walgreens/Option Care at Legacy
11.2008 - 10.2015

Bachelor of Science - Finance

Portland State Un

Bachelor of Science - Psychology

Portland State University

Similar Profiles

CREATE PROFILE
Santhary Saing
Want your own profile? Create for free at LiveCareer.com