Sara Solle
Bonney Lake
Summary
Health Information Management expert with over 14 years of extensive experience in claims processing, system configuration, and quality assurance within the healthcare sector. Demonstrates exceptional skills in team leadership and cross-functional collaboration, driving innovative solutions to enhance compliance and operational efficiency. Passionate about improving healthcare systems through advanced techniques and continuous process improvement.
Results-driven professional with expertise in data management and claims processing. Proven track record in enhancing operational efficiency through streamlined processes and cross-functional collaboration.
Overview
4
4
years of professional experience
Work History
Lead Membership Coordinator
Kaiser Permanente
06.2022 - 09.2024
- Configure systems for accurate claims processing and benefit adjudication
- Validated claims processing data ensuring precise payments
- Led team training sessions to enhance skills and efficiency
- Collaborated with teams to improve contract interpretation
- Managed provider information updates in proprietary systems
- Executed comprehensive quality control measures for membership data integrity, ensuring compliance with healthcare regulations and internal protocols
- Improved member onboarding efficiency through systematic process refinement and enhanced communication channels with healthcare providers
- Initiated automated verification procedures for membership status updates, significantly reducing manual processing time and error rates
- Streamlined membership data verification protocols and implemented systematic quality control measures, enhancing compliance standards, and reducing processing errors
- Developed automated membership status verification procedures, optimizing operational efficiency, and minimizing manual processing requirements
- Facilitated cross-functional team coordination for contract interpretation improvements, strengthening provider relationships and claim accuracy
- Orchestrated comprehensive system configurations for precise claims processing, ensuring accurate benefit adjudication and payment validation
- Implemented streamlined data validation protocols for healthcare claims, enhancing accuracy in benefit calculations and ensuring compliant provider payments
- Spearheaded system optimization initiatives for membership verification, substantially reducing processing time while maintaining data integrity
- Fostered interdepartmental partnerships to refine contract interpretation processes, strengthening provider relationships and improving claim resolution
- Designed automated membership status verification workflows, transforming manual processes into efficient digital solutions
- Orchestrated comprehensive quality control measures for membership data, ensuring adherence to healthcare regulations while minimizing errors
- Coordinated membership outreach initiatives to enhance member engagement strategies.
- Managed membership database updates to ensure accurate and timely information.
- Responded to member inquiries, resolving issues and providing assistance promptly.
- Worked closely with accounting department on billing inquiries from members.
- Developed and implemented membership policies and procedures.
- Maintained accurate records of all membership transactions using CRM software.
- Assisted with the development of promotional materials for membership campaigns.
- Coached and mentored all employees to be engaging, pleasant, and helpful to new and existing members, which improved service expectations.
- Oversaw membership data system to keep information updated and complete.
- Promoted effective issue resolution regarding employees or members through active listening and dynamic communication skills.
- Generated weekly metrics reports on membership growth, usage, retention rates.
- Collaborated with marketing team to develop strategies for increasing membership sign-ups.
- Managed the maintenance of member records, including contact information updates.
- Assisted in the preparation of annual budget projections related to membership operations.
- Resolved escalated customer service complaints from members in a timely manner.
- Reviewed applications from prospective members and determined eligibility criteria.
- Responded promptly to emails or phone calls from current or potential members.
- Organized monthly events for members and facilitated communication between members and staff.
- Engaged in conversation with customers to understand needs, resolve issues and answer product questions.
- Supported sales team members to drive growth and development.
- Enhanced productivity and customer service levels by anticipating needs and delivering outstanding support.
- Promoted high customer satisfaction by resolving problems with knowledgeable and friendly service.
- Exceeded established service goals while leveraging customer service, sales, and employee management best practices.
- Recommended improvements in products, service and billing methods to management to prevent future problems.
- Coordinated with internal teams to ensure timely and successful delivery of solutions according to client needs.
Lead PSA – Configuration Specialist I - Contract Remote
Kaiser Permanente
12.2021 - 06.2022
- Configured systems for accurate claims processing, enhancing efficiency and compliance.
- Collaborated with departments to refine contract interpretations, optimizing system requirements.
- Conducted user acceptance testing to ensure system reliability and functionality.
- Managed provider information updates, facilitating seamless integration into systems.
- Led system configuration for authorizations, optimizing benefit structures and accurate adjudication.
- Partnered with IT and Contracting teams to refine benefit structures, ensuring precise interpretation and seamless integration of healthcare systems.
- Managed comprehensive provider database updates, validating system integrity and maintaining accurate practitioner information across platforms.
- Implemented advanced configuration methodologies for multiple healthcare systems, optimizing benefit interpretation and claims processing efficiency.
- Streamlined authorization workflows through strategic system configurations, reducing processing bottlenecks and enhancing claim accuracy
- Implemented cross-departmental benefit structure improvements, driving operational efficiency and minimizing processing errors
- Orchestrated system upgrades with IT teams to modernize healthcare platforms, ensuring robust provider data management and compliance
- Configured system settings for electronic health records to enhance data accuracy.
- Collaborated with cross-functional teams to streamline workflow processes and improve efficiency.
- Conducted audits on configuration changes to ensure compliance with healthcare standards.
- Provided training and support for end-users on new system functionalities and features.
- Analyzed user feedback to identify areas for improvement in configuration processes.
- Developed documentation for configuration procedures and system updates for reference.
- Assisted in implementing upgrades and patches to maintain system integrity and security.
- Monitored system performance and resolved technical issues in a timely manner.
- Maintained software configurations to ensure data integrity and accuracy.
- Assisted with the development of policies, standards, guidelines and procedures for system administration.
- Analyzed user requirements to develop technical solutions that met business needs.
- Coordinated with vendors regarding product compatibility and feature availability when selecting new technologies or upgrading existing ones.
- Performed software patch management activities across multiple systems.
- Maintained accurate inventory records of hardware and software assets and ensured compliance with license agreements.
- Configured servers according to customer specifications using established processes and toolsets.
- Provided technical support for hardware and software issues related to system configuration.
- Created detailed reports on system configurations, changes and upgrades.
- Resolved complex configuration issues by analyzing logs, identifying root cause of problem, researching possible solutions, testing fixes, documenting results.
- Conducted server setup, configuration and deployment for multiple applications.
- Identified gaps between existing environment and desired end state when configuring new systems or making changes to existing ones.
- Trained users on proper use of installed applications and provided ongoing support as needed.
- Managed user accounts within Active Directory; configured access rights and privileges as needed.
- Implemented strategies to improve security posture of systems through comprehensive security reviews.
- Monitored system performance to identify potential problems in a timely manner.
- Developed test plans and scripts for verifying functionality after changes were made to the environment.
- Documented all aspects of system configurations including hardware and software components, network settings.
- Developed and maintained system installation, configuration and troubleshooting procedures.
- Evaluated current systems architecture against industry best practices for scalability, reliability and performance.
- Developed and managed project plans while providing status updates to management.
- Tested, maintained and monitored computer programs and systems.
- Explored new technologies and tools for productivity, security, and quality assurance purposes.
- Developed, documented and revised system design procedures and quality standards.
- Expanded or modified system to serve new purposes or improve workflow.
- Prepared and presented technical proposals for clients.
- Maintained quality-focused performance benchmarks and schedules when directing project teams.
- Consulted with management to reach agreement on system principles.
- Used computer in analysis and solution of business problems.
- Conferred with clients regarding information processing or computation needs.
- Streamlined acquisition of reporting requirements and specifications to disseminate across multiple business lines and IT support teams.
- Defined system goals and devised flow charts and diagrams describing logical operational steps.
- Reviewed and analyzed computer printouts and performance indicators to locate code problems and correct errors.
- Assessed usefulness of pre-developed application packages and adapted to user environment.
- Mapped industry standard design patterns to existing code base to derive component architecture model of system.
- Investigated department processes and facilitated company becoming ISO9000-qualified.
Lead Credit Balance Reconciliation Representative - Contract Remote
Providence | Swedish Health Services
09.2021 - 11.2021
- Managed clinical data entry, ensuring HIPAA compliance and precise billing with ICD-10, CPT codes.
- Resolved data discrepancies, enhancing healthcare reporting accuracy and patient record access.
- Led data projects, achieving significant system updates and improved remote operations efficiency.
- Processed medical claims, ensuring compliance and reducing account reconciliation resolution time.
- Collaborated cross-functionally to enhance patient financial experience and streamline claims processing.
- Integrated digital solutions for credit balance workflows, strengthening data accuracy and team efficiency in remote operations
- Facilitated interdepartmental communication to resolve complex billing challenges, ensuring seamless patient financial experiences
- Orchestrated medical claims processing and credit balance reconciliation while maintaining strict HIPAA compliance and data accuracy standards
- Streamlined digital workflows for remote operations, optimizing cross-functional collaboration and enhancing system efficiency
- Resolved complex billing discrepancies through systematic data analysis, improving healthcare reporting accuracy and patient record management
- Facilitated seamless interdepartmental communication to address billing challenges and enhance overall patient financial experience
- Reviewed and resolved discrepancies in patient billing and accounts.
- Collaborated with healthcare teams to ensure accurate financial reporting.
- Utilized reconciliation software to track and analyze account balances.
- Communicated with patients regarding billing inquiries and payment options.
- Assisted in developing streamlined processes for account reconciliation tasks.
- Coordinated with insurance providers to clarify claim statuses and payments.
- Documented findings and maintained records for compliance audits.
- Trained new staff on reconciliation procedures and reporting tools.
- Researched unpaid invoices, payments, refunds and other transactions.
- Reviewed and reconciled accounts receivable and payable transactions.
- Analyzed changes in account balances over time to detect any irregularities or trends in activity levels.
- Identified potential issues before they became problems by performing thorough reviews of data sets.
- Advised management on best practices for improving existing procedures related to reconciliations and reporting activities.
- Assisted with month-end close process by preparing journal entries for accruals and adjustments as needed.
- Provided technical assistance to team members when necessary regarding reconciliation processes and procedures.
- Developed new reconciliation processes to improve efficiency and accuracy.
- Maintained accurate records of all reconciliations performed.
- Created detailed reports for management review regarding reconciliation findings.
- Participated in special projects as required related to account reconciliations or other finance initiatives.
- Ensured compliance with generally accepted accounting principles while completing reconciliations.
- Processed customer payments accurately in the accounting system.
- Performed complex research on account balances to identify errors or inconsistencies.
- Performed additional duties as assigned by senior management such as preparing ad hoc reports or analysis.
- Conducted periodic reviews of open items lists ensuring timely resolution of outstanding items.
- Received and recorded cash, checks and transfers.
- Recorded debit, credit and account transactions in computer spreadsheets and databases.
- Prepared bank deposits by verifying and balancing receipts and sending cash and checks to banks.
- Performed bookkeeping and accounting consulting services.
- Checked postings and documents for correctness, accuracy and proper coding.
- Reconciled computer reports with manually maintained ledgers.
- Reconciled or entered report discrepancies found in financial records.
- Reduced financial discrepancies by verifying accounting statements.
- Classified and summarized financial data to compile and enter in financial records
- Calculated and produced checks for utilities, taxes and other operational payments.
- Performed financial calculations for amounts due, interest charges and balances.
Lead Medical Claims Adjuster
Optum
08.2020 - 07.2021
- Analyzed policy details to determine coverage and resolve claims efficiently.
- Investigated complex claims, collaborating with medical professionals for accurate outcomes.
- Enhanced claims processing speed by refining documentation methods and maintaining accuracy.
- Delivered clear communication to clients, ensuring understanding of claim decisions.
- Maintained industry expertise through continuous training and networking.
- Streamlined claims resolution workflow by implementing efficient documentation methods and maintaining comprehensive electronic records
- Delivered exceptional customer service by providing clear benefit decisions and facilitating smooth claim settlements
- Enhanced claims processing efficiency through active participation in industry training and staying current with healthcare regulations
- Optimized claims processing through detailed policy analysis and medical documentation review, establishing consistent resolution protocols for complex cases
- Developed streamlined documentation methods that reduced claim resolution time while maintaining high accuracy standards
- Built strong partnerships with healthcare providers to expedite medical reviews and ensure accurate claim determinations
- Reviewed medical claims for accuracy and compliance with policy guidelines.
- Investigated discrepancies in claims through detailed analysis and communication.
- Collaborated with healthcare providers to clarify billing issues and claim details.
- Processed claims using proprietary software to ensure timely approvals.
- Advised team members on best practices for claims resolution and processing.
- Documented claim adjustments and maintained accurate records of changes made.
- Assisted in training new adjusters on company systems and procedures.
- Engaged with clients to resolve inquiries and provide support on claim status updates.
- Resolved complex claim issues through research, negotiation, and collaboration with other departments.
- Maintained accurate records of all activities related to claim adjustments.
- Performed quality assurance reviews of submitted insurance claims prior to payment approval.
- Identified trends in claim rejections or denials and provided feedback to management team.
- Conducted periodic audits of existing processes used for adjusting medical claims.
- Developed strategies for reducing costs associated with claims processing.
- Verified that payments were made according to contracted terms between provider and insurer.
- Processed incoming electronic health records from physicians' offices into a secure database.
- Evaluated potential fraud cases involving healthcare providers or patients as necessary.
- Provided customer service support to healthcare providers regarding denied or disputed claims.
- Monitored changes in state regulations pertaining to insurance coverage for medical services.
- Analyzed medical claims for accuracy, completeness, and compliance with company policies and procedures.
- Advised healthcare providers on proper coding techniques when submitting insurance claims.
- Investigated discrepancies in medical billing codes, patient information, and other data related to claims processing.
- Responded promptly to inquiries from members about their benefits or coverage status.
- Reviewed medical records to determine the appropriateness of services rendered and billed by healthcare providers.
- Compiled weekly reports summarizing the status of pending medical claims.
- Documented all decisions made on claims in accordance with established guidelines.
- Participated in training sessions designed to keep current on industry-specific regulations.
- Stayed current on HIPAA regulations, benefits claims processing, medical terminology and other procedures.
- Reviewed claims for accuracy before submitting for billing.
- Tracked differences between plans to correctly determine eligibility and assess claims against benefits and data entry requirements.
- Evaluated pending claims to identify and resolve problems blocking auto-adjudication.
- Accurately processed large volume of medical claims every shift.
- Sent clinical request and missing information letters to obtain incomplete information.
- Based payment or denials of medical claims upon well-established criteria for claims processing.
- Reviewed administrative guidelines whenever questions arose during processing of claims.
- Used contract notes and processing manual to correctly apply group-specific classifications to claims.
- Inputted data into the system, maintaining accuracy of provider coding information and reported services.
- Administered standard contract benefits to process pending claims for dental benefits.
- Reviewed policies to determine appropriate levels of coverage and assist with approval or denial decisions.
- Input claim information and payments into company database.
- Explained loss coverage, assisted policyholders with itemizing damages and coordinated alternative living arrangements.
- Reviewed police reports, medical treatment records, medical bills and physical property damage to determine extent of liability.
- Investigated properties, classified damages and created estimates outlining repair costs.
- Conducted secondary evaluations of original investigations documentation and reports to facilitate smooth resolutions.
- Checked into questionable claims, interviewing agents and claimants to resolve errors and omissions.
- Analyzed information gathered by investigations and reported findings and recommendations.
- Reduced loss ratios through fair and prompt processing of claims.
- Drafted statement of loss to summarize damages, payments and underlying policy coverage.
- Discussed current cases and issues in claim committee meetings.
- Verified liability extent with reviews of police reports, medical treatment histories and other records.
- Communicated with reinsurance brokers to obtain claim information for processing.
- Traveled to customer sites to evaluate fallen trees, leaking roofs and other issues to create accurate cost estimations.
- Coordinated emergency repair, cleaning companies and contractors to optimize customer claim handling.
- Contacted banks to acquire credit information.
- Coordinated with law enforcement and testified at criminal proceedings.
Lead Patient Account Representative II – Contract Remote
Jefferson Healthcare
04.2020 - 08.2020
- Processed insurance claims, ensuring compliance and timely reimbursement.
- Resolved discrepancies, reducing outstanding balances and enhancing approval rates.
- Utilized Epic for accurate documentation and reconciliation of claims.
- Verified coverage, optimizing workflows and reimbursement cycles.
- Coordinated with providers to expedite complex billing resolutions.
- Orchestrated complex billing reconciliation processes across multiple healthcare portals while maintaining strict compliance standards
- Facilitated seamless communication between healthcare providers and insurance carriers to expedite resolution of complex claim disputes
- Developed systematic approach to workers' compensation claims management, enhancing processing efficiency and reducing payment delays
- Streamlined insurance claims processing through Epic system integration, establishing efficient workflows and reducing outstanding claim resolution time
- Led cross-functional collaboration with healthcare providers to resolve complex billing disputes, improving first-contact resolution rates
- Implemented systematic workers' compensation claims management protocol, enhancing processing accuracy and expediting payment cycles
- Managed patient accounts and resolved billing inquiries efficiently.
- Processed insurance claims using electronic health record systems.
- Coordinated with healthcare providers to verify patient information.
- Assisted patients with financial arrangements and payment plans.
- Educated patients on insurance benefits and coverage options.
- Collaborated with team members to improve account management processes.
- Maintained accurate records of patient interactions and transactions.
- Responded to patient concerns with empathy and professionalism.
- Provided customer service to patients regarding billing inquiries and account information.
- Analyzed claims denials from third party payers and identified potential solutions for reimbursement.
- Researched discrepancies in patient accounts to determine appropriate resolution.
- Processed payments from patients and maintained accurate records of all transactions.
- Verified accuracy of medical coding for services rendered by healthcare providers.
- Reviewed EOBs statements submitted by insurance companies for accuracy against provider's charges.
- Updated existing patient files with relevant information such as changes in address or contact information.
- Compared statements against patient files.
- Resolved any issues arising from incorrect or incomplete documentation relating to a particular claim.
- Collaborated with relevant parties to resolve billing issues, insurance claims, and patient payments.
- Maintained detailed notes on all patient interactions for future reference purposes.
- Conducted follow-up calls with patients to ensure that accounts were up to date and properly documented.
- Submitted appeals on behalf of patients when appropriate based on findings from research conducted into denied claims.
- Worked closely with insurance companies to obtain authorization for services rendered.
- Ensured compliance with company policies concerning the privacy of confidential health information.
- Interacted with other departments within the organization such as finance, accounting, IT, and Human Resources when necessary.
- Submitted electronic bills following facility and legal compliance standards.
- Reconciled payments received against outstanding invoices ensuring proper posting of credits and debits.
- Communicated frequently with healthcare providers regarding payment status updates on their claims submitted.
- Assisted in resolving patient complaints related to account balances, insurance coverage, and payment plans.
- Generated detailed reports outlining billing, flagged items, and other important data.
- Initiated collection activities on delinquent accounts while adhering to HIPAA guidelines and regulations.
- Organized and maintained office supplies to promote team productivity.
- Resolved inquiries from patients, families, and external payers.
- Created new patient files according to established procedures and protocols.
- Applied organizational policies and complied with regulations for patient privacy.
- Reached out to patients once insurance was billed in order to obtain payments due.
- Performed monthly reconciliations of patient accounts to ensure accuracy of financial data.
- Responded promptly to customer inquiries via telephone or email in a professional manner.
- Maintained confidentiality of patient information in compliance with HIPAA regulations.
- Answered telephones, directed calls, and took messages.
- Reviewed files, records and other documents to obtain information or respond to requests.
- Communicated with customers, employees and vendors to answer questions and address complaints.
- Maintained and updated filing, inventory and database systems, manually or using computer.
- Operated photocopiers and scanners, facsimile machines and personal computers.
- Copied, sorted and filed records of office activities and business transactions.
- Delivered messages and ran errands.
- Computed, recorded and proofread data or reports.
- Typed, formatted and edited correspondence and other documents.
- Collected and entered payment data into system, maintaining complete confidentiality and accuracy.
- Opened, sorted and routed incoming mail and prepared outgoing mail.
- Developed organizational filing systems for confidential customer records and reports.
- Completed and mailed contracts, invoices or checks.
- Sorted and distributed incoming mail, dispersing to appropriate departments and personnel.
- Monitored office supply stock levels and placed timely orders for replenishment.
- Inventoried and ordered materials, supplies and services.
- Trained staff members to perform work activities and use computer applications.
- Collected, counted and disbursed money to complete basic bookkeeping and banking transactions.
- Scheduled meetings and coordinated materials to be distributed to attendees.
- Troubleshot office equipment, computer hardware and software issues.
- Coordinated office activities to streamline operations and promote compliance with organizational policies.
- Monitored and directed work of lower-level clerks.
- Prepared meeting agendas, attended meetings and recorded and transcribed minutes.
- Identified issues and utilized emotional intelligence and diplomatic communication to defuse.
- Processed and prepared business or government forms and expense reports.
- Coordinated travel arrangements for office personnel.
- Coordinated travel arrangements and accommodations for staff members.
Education
Bachelor of Administration - Healthcare
Southern New Hampshire University
01.2025 - 01/2025
Associate in Science - Health Information Management
DeVry University
12.2019 - 06/2020
Medical Assistant Diploma -
Everest College
Tacoma, WASkills
- System Configuration
- Data Management
- UAT Testing
- Unit Testing
- Claims Processing
- Project Management
- Healthcare
- Epic EMR
- HIPAA
- Medical Billing
- Team Leadership
- Quality Assurance
- Patient Care
- Medical Records
- Cross-Functional Collaboration
- Process Improvement
- Operational Efficiency
- Training Development
- Data Integrity
- Change Management
- Automation Strategies
- Data Analytics
- Workflow Optimization
- Customer Engagement
- Regulatory Compliance
- Risk Management
- Information Security
- Technical Documentation
- Healthcare compliance
- Data analysis
- Team collaboration
- System configuration
- Process improvement
- Medical billing
- Effective communication
- Membership processing
- Written and oral communication
- CRM software
- Team Training
- Database management
- Program improvement
- Excellent communication
- Teamwork and collaboration
- Analytical thinking
- Task prioritization
- Teamwork skills
- Project management
- Work prioritization
- Problem-solving aptitude
- Data management
- Process transactions
- Remote office availability
Timeline
Bachelor of Administration - Healthcare
Southern New Hampshire University
01.2025 - 01/2025
Lead Membership Coordinator
Kaiser Permanente
06.2022 - 09.2024
Lead PSA – Configuration Specialist I - Contract Remote
Kaiser Permanente
12.2021 - 06.2022
Lead Credit Balance Reconciliation Representative - Contract Remote
Providence | Swedish Health Services
09.2021 - 11.2021
Lead Medical Claims Adjuster
Optum
08.2020 - 07.2021
Lead Patient Account Representative II – Contract Remote
Jefferson Healthcare
04.2020 - 08.2020
Associate in Science - Health Information Management
DeVry University
12.2019 - 06/2020
Medical Assistant Diploma -
Everest College