Shannon Saldutti
West Norriton,PA
Summary
Experienced payer relations and credentialing specialist with strong expertise in Medicare/Medicaid enrollment, XIFIN system optimization, and cross-functional collaboration. Known for streamlining processes, resolving complex enrollment issues, and mentoring teams to improve operational efficiency.
Overview
14
14
years of professional experience
Work History
Payer Enrollment, Credentialing & Payer Relations
RMX Monitoring, LLC
Mt. Laurel, NJ
01.2016 - Current
- Lead Medicare and Medicaid enrollment processes, including PECOS updates, CMS-855B submissions, and state-specific applications.
- Resolve complex enrollment deficiencies by developing strategic documentation and coordinating with legal counsel.
- Serve as the primary XIFIN File Maintenance point of contact, optimizing payer setup, workflows, and system integration.
- Train staff on XIFIN processes, payer add workflows, fee schedule templates, DX library maintenance, and case submission protocols.
- Conduct in-depth payer research to support policy interpretation, coverage clarification, and strategic decision-making.
- Mentor and train staff on payer relations best practices, XIFIN workflows, and communication standards.
- Collaborate cross-functionally with sales, billing, and compliance to resolve payer inquiries and streamline processes.
- Provide guidance to team members by troubleshooting enrollment hurdles and clarifying payer requirements.
- Monitor payer portals and credentialing timelines to ensure compliance and timely submissions.
- Support operational excellence by preparing for NJ notary certification and contributing to SOP development.
Managed Care Coordinator
RMX Monitoring, LLC
Mt. Laurel, NJ
01.2016 - Current
- Manage all HealthFusion ERA posting, ensuring accurate and timely payment application across all payers.
- Resolve all HealthFusion posting flags, including manual and auto-posting failures, and correct prior posting errors.
- Oversee ERA retrieval and posting from a multitude of separate payer portals not integrated with HealthFusion, including both payments and denials.
- Process paper EOBs as needed to maintain complete and accurate reimbursement records.
- Serve as the senior resolution specialist for complex patient account issues, including incorrect balances, misapplied payments, and general account discrepancies.
- Determine appropriate adjustment, write-down, and write-off actions, ensuring accuracy and preventing incorrect patient statements.
- Coordinate with internal team members (e.g., Jen, Yvette) to obtain payer-required documentation for account reconciliation.
- Act as the primary Medicare AR contact, performing follow-up on delayed receivables and resolving outstanding issues.
- Provide cross-functional support to the reimbursement team, including denial research, payer correspondence, and process improvement initiatives.
Contracting Specialist
BIOTELEMETRY INC.
Malvern, PA
05.2012 - 10.2015
- Assisted in researching and filing Appeals/Redeterminations for Medicare Pre/Post Pay Audits; RAC and CERT reviews.
- Reviewed medical necessity claim edits and Correct Coding Initiative (CCI) edits for Medicare, Medicare Replacements, Medicaid and Other Government Plans.
- Assessed clinical documentation for supporting medical necessity to appeal denials or audits when appropriate for Medicare.
- Identified trends in edits and denials, reporting them to the manager.
- Assisted in the education to providers or departments for denial resolutions.
- Analyzed denials that did not get stopped by an edit and report possible system issues to manager.
Intake Coordinator
BIOTELEMETRY INC.
Malvern, PA
05.2012 - 10.2015
- Performed insurance verification/authorizations from organizations that were at risk to ensure services were authorized and reimbursable prior to providing service.
Education
WEST CHESTER UNIVERSITY
West Chester, PA01-2012
High School Diploma - undefined
UPPER MERION HIGH SCHOOL
King of Prussia, PA01-2011
Skills
- Payer Enrollment
- Credentialing
- Medicare/Medicaid Processes
- Staff Training & Mentorship
- Payer Policy Interpretation
- Root-Cause Analysis
Timeline
Payer Enrollment, Credentialing & Payer Relations
RMX Monitoring, LLC
01.2016 - Current
Managed Care Coordinator
RMX Monitoring, LLC
01.2016 - Current
Contracting Specialist
BIOTELEMETRY INC.
05.2012 - 10.2015
Intake Coordinator
BIOTELEMETRY INC.
05.2012 - 10.2015
High School Diploma - undefined
UPPER MERION HIGH SCHOOL
WEST CHESTER UNIVERSITY