Sarah Liu

Focused on raising children while maintaining organizational and time-management skills.

• Coordinated efforts between the health plan and the configuration team to build and maintain all health plan contracts and fee schedules.
• Maintained accuracy of provider demographic records by efficiently preparing and submitting required documentation.
• Prepared and submitted projects for claims rework; responsible for estimating financial impact for CFO prior to submission.
• Served as the Network Operations team representative on daily DMS conference calls.
• Participated in weekly SAI meetings and collaborated with the medical economics team to identify cost-saving opportunities.
• Represented Network Operations in weekly discussions with Shared Services to ensure alignment and issue resolution.

Key Accomplishments

• Promoted from Consultant to Senior Consultant in October 2018.
• Completed a massive clean-up of fee schedule and contract configuration data.
• Reviewed paper agreements and cleaned up all hospice, home health, and psychiatric residential treatment facilities within the Kentucky network to ensure correct payment.
• Reviewed all hospital contracts and prepared rate files to update rates for all hospitals in Kentucky as well as out-of-state hospitals.
• Standardized the payment methodology used for out-of-state facilities.
• Streamlined the provider contract and fee table configuration process for the Kentucky and Louisiana health plans.

• Responsible for the creation and maintenance of all health plan contracts and fee tables. Ensured new contracts, amended contracts, and State fee schedule rates were submitted with detailed source files to the configuration team for timely loading. Short turnaround times, typically within 30 days, reduced the amount of interest and penalties incurred by the health plan.
• Maintained network data for 5 large hospital systems in the state of Missouri, which included the loading and updating of the providers affiliated with these systems.
• Maintained demographic data for the entire central Missouri region, which included 41 counties.
• Actively worked the pended claims report several times per week to keep aged claims minimal and reduce interest and penalties.

Key Accomplishments

• Worked with the VP of Network Management to develop a fee schedule matrix for the Missouri health plan. This matrix identified existing fee tables, provided a detailed description of reimbursement methodology, and timeframes for required updates.

• Maintained all fee schedules and contract maintenance for the Missouri network.
• Worked closely with the contracting team to interpret provider agreements. Prepared rate and methodology source files to initiate configuration updates to match State and contract requirements.
• Responsible for maintaining various delegated and non-delegated provider groups across the State of Missouri to ensure provider data was accurate.
• Managed pended claims which included detailed research of billing and/or set up issues to ensure claims are processed within a timely manner and accurately.
• Handled provider returned mail. Researched provider data issues, which resulted in returned mail.
• Reviewed all initial credentialing applications and provided follow-up with provider offices to obtain missing or outdated information. Submitted initial credentialing applications to the Credentialing Verification Center for verification for review.
• Reviewed member complaints and contacted provider offices to provide education on balanced billing. Quality of service issues were documented and forwarded to the appropriate Provider Relations Representative for follow-up.
• Documented all site visits completed for credentialing or in response to member quality of service complaints. Required for NCQA accreditation.
• Handled all voice messages left on the department voicemail.
• Worked with provider offices to complete and sign contracts to expand the network.
• Assisted with delegated audits, relating to URAC and NCQA accreditation.

Key Accomplishments

• Promoted to a senior position in August 2013.
• Provided assistance in testing new databases to ensure provider OIG data is stored for credentialing and NCQA compliance purposes.
• Reinstated the Washington University Physician Network, resulting in the loading of approximately 2,600 new providers.
• Documented and organized ACA amendments to provide additional reimbursement to board certified and high-volume primary care practitioners. Worked with my manager to implement the ACA system setup to ensure providers received the correct reimbursement.
• Participated in IDX testing as the Missouri health plan moved from HCAMGR to MEDMGR. Worked on a team to test IDX data to identify transfer data issues and glitches.
• Assisted in the acquisition of Family Health Partners, a Missouri/Kansas health plan purchased by Coventry. Worked on the analysis of the FHP provider network in comparison to the HealthCare USA provider network and identified any discrepancies.
• Created and revised provider collaterals.