Sharla Van Orman
Ogden,UT
Summary
Results driven Medical Biller with over 27 years of hands-on experience in account management, revenue generation and medical billing and coding. Accomplished in developing strategies to improve workflows and processes and actualizing procedures to enhance revenue generation. Demonstrated leadership skills guide teams towards success, optimize performance and sustain organizational success.
Overview
18
18
years of professional experience
Work History
REIMBURSEMENT SPECIALIST
Myriad Genetics Inc
salt lake city, UT
02.2021 - Current
- Initiate contact for educational purposes with providers via telephone or electronic methods about third-party vendors for authorization
- Provide information and set a follow-up time to call and discuss questions or concerns providers have about enrollment with third-party authorization vendors
- Document any point of contact changes for providers
- Update internal systems with new information and relay information to sales team when necessary
- Maintain status notes in database/spreadsheets and ensure timely follow up on enrollment, questions, and concerns
- Upon receipt of enrollment verification, communicate enrollment updates and/or questions to internal team members
- Establish and maintain a strong professional rapport with providers, third party vendors, and internal team members
- Responsible for collecting on all outstanding balances for a specific group of payers or patient accounts to assure maximum reimbursement
- Work aging accounts, process appeals or corrected claims, research and reconcile credit balance accounts and process adjustments
- Participate in the Quality Assurance plan
- Comply with applicable CLIA and HIPPA regulations
- Volunteer to help other teams complete work
- Display teamwork, professionalism, and time management.
REFUND ADJUSTMENT SPECIALIST/CLAIMS SERVICE ANALYST
Regence blue cross blue shield
salt lake city, ut
10.2005 - 02.2021
- Reviewed claims to ensure proper coding and payment using department policies and procedures, reimbursement policy, and provider and member contract material
- Interpreted claim history, medical records and pre-authorization determinations as needed to support review
- Worked with outside vendors to analyze and manage claims data such as new audit concepts, claims adjustments and processing feedback
- Identified and initiated internal adhocs
- Verified information and pursued payments from member and providers through negotiating payment plans
- Handled provider appeals based on vendor decisions
- Captured and recorded accurate recovery savings in a timely manner
- Made informed decisions regarding claims
- Processed multiple claim types and product lines
- Identified any irregularities/trends in claim adjustments
- Ongoing knowledge of HIPPA guidelines
- Developed solutions to process improvement
- Managed special projects and work groups as assigned
- Mentored and trained.
Education
Associate degree -
Weber State University
Diploma -
Bonneville High School
Skills
- Microsoft Excel and Office proficiency
- Knowledgeable of insurance and reimbursement processes
- Medical records and authorization
- Customer/provider relations
- ICD-10, CPT & HCPCS coding
- Leadership skills/business owner
- Problem resolution ability
- Resourceful
- Medical Terminology
- Salesforce
- Organized
- EDI
Timeline
REIMBURSEMENT SPECIALIST
Myriad Genetics Inc
02.2021 - Current
REFUND ADJUSTMENT SPECIALIST/CLAIMS SERVICE ANALYST
Regence blue cross blue shield
10.2005 - 02.2021
Associate degree -
Weber State University
Diploma -
Bonneville High School
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