Sharon Garrity
Billerica
Overview
10
10
years of professional experience
Work History
Denials Analyst
Lawrence General Hospital
06.2023 - Current
- Review coding request for accuracy. Provide feedback when necessary.
- Review monthly adjustments by denial report finding to director along with root cause of denial.
- Find denial trends by payor(s) along with individual payor policy for system edit and/or auto adjustments.
- Provide Education and Job aids to denial rep including examples of successful appeals by denial.
- Attend monthly Denial meetings providing prior month denials and suggestions for denial reductions.
- Identify payor trends, and denial issues, report to director.
- Work with Revenue Integrity identifying claim and coding issues.
Denials Specialist
Atrius Healthcare
03.2020 - 05.2023
- Adjust/appeal denials based on CMS/Payor policies and guidelines.
- Review daily charges, CPT Codes, diagnosis, modifiers, following payor policies and CMS guidelines prior to claim submission.
- Identify payor trends, and denial issues, report to senior leadership.
- Suggest system edits and policy changes.
- Attend CMS, PHC, and webinars expanding my knowledge base while continuing my education.
- Patients inquire/dispute review.
- Assist customer service with patient balance inquiry/dispute.
- Review denial reports assign spreadsheets to correct account rep.
- Review chart/op notes for coding errors.
- Correct claim issues incorrect CPT/DX/Modifier based chart review.
- Forward requested information to payers for additional reimbursement.
- Review charges based on system edits, make corrections to eliminate possible denials.
- Assist teammates with questions or work assignments as necessary.
- Verify patient eligibility via online payer portals as well as NEHEN.
- Work special projects to increase revenue as required.
Consultant – Revenue Cycle Coding/Denial Recovery
Armco Partners
06.2019 - 02.2020
- Review various client denials provider feedback on ways to prevent future denials.
- Review coding specific denials in accordance to CMS Guidelines.
- Educate account contact on coding guidelines, processes to assist with the highest level of specificity for appropriate level of reimbursement.
- Review workflows in conjunction with client specification creating the most efficient process.
- Review payor denials for coding corrections.
- Communicate coding rationale to denial supervisors to aid denial reps with coding questions.
- Create guides to assist denial analysts to streamline denial placements.
- Assist payment recovery team on tracking payments faster.
- Review client inventories, for up to date, active, paid denied and appeals status.
Professional Coder
Lahey Shared Services
07.2018 - 06.2019
- Review Provider submitted charges for accuracy. Make necessary corrections prior to submission to insurance carriers.
- Code all pulmonary procedure, verifying all services billed accurately within CMS coding guidelines for highest level of service.
- Educate provides on coding guidelines, processes to assist with the highest level of specificity for appropriate level of reimbursement.
- Assist on special projects, when required.
- Review payor denials for coding corrections.
- Communicate coding rationale to denial supervisors to aid denial reps with coding questions.
- Create Epic shortcuts for faster claims submissions and provider communication.
Supervisor Patient Accounts
Lahey Shared Services
09.2016 - 07.2018
- Supervise team of 8 direct reports account representatives.
- Monitor six denial work queues and assign work to team members based on payor/carrier.
- Review staff weekly assignments.
- Track team’s productivity, work colleagues when below department benchmark.
- Assist colleagues with denial questions assist with completing appeals.
- Review patient charts for team members prior to requesting coding review.
- Provide colleagues with underlying services in patients charts whenever possible.
- Work with coding supervisors on payor denials based on coding guidelines.
- Conduct weekly team meetings.
- Review denial work queues for denial trends.
- Review claims system edits on denials for potential updates.
- Monitor account WQ’s associated with patient complaints, assign weekly.
- Monitor credit balance WQ for undistributed payment associated with coding corrections resulting in reprocessing claims.
Revenue Integrity Specialist
Boston Pain Care
06.2015 - 08.2016
- Verify insurance information is accurate.
- Review physician notes, daily surgery level sheets, verify all services are entered at highest level.
- Inquire with clinical staff to ensure correct billing to obtain highest revenue.
- Import daily payments and post to correct invoices balancing to daily deposits.
- Post daily payments for correct reimbursement.
- Submit real time appeals on denials and inquiries on underpaid or denied claims.
- Assist patients with questions regarding insurance and self-pay balances.
- Obtain prior authorization from insurance companies or third-party vendors where necessary.
- Review A/R reports for claims over 45 days old work accordingly highest dollar/oldest dates of service.
- Call carriers on outstanding appeals, claims and questionable denials.
- Compare worker compensation payments with negotiated rates for accurate reimbursement.
- Submit charges to clearing house reconciling and correcting rejections for resubmission.
Education
Professional Coding - ICD-10, HCPCS and CPT coding guidelines
Salter School Malden
Malden05.2017
Medical Billing and Coding -
Salter School Tewksbury
Tewksbury01.2005
Graduated -
Billerica Memorial High School
BillericaSkills
- Problem solving
- Computer skills
- Excel
- Word
- Positive working attitude
- Collaboration
- Detail oriented
- Highly motivated
- Reimbursement management
References
Available upon request.
Personal Information
Title: Certified Professional Coder/Denials Specialist
Timeline
Denials Analyst
Lawrence General Hospital
06.2023 - Current
Denials Specialist
Atrius Healthcare
03.2020 - 05.2023
Consultant – Revenue Cycle Coding/Denial Recovery
Armco Partners
06.2019 - 02.2020
Professional Coder
Lahey Shared Services
07.2018 - 06.2019
Supervisor Patient Accounts
Lahey Shared Services
09.2016 - 07.2018
Revenue Integrity Specialist
Boston Pain Care
06.2015 - 08.2016
Professional Coding - ICD-10, HCPCS and CPT coding guidelines
Salter School Malden
Medical Billing and Coding -
Salter School Tewksbury
Graduated -
Billerica Memorial High School