SHERINETA MORRISON

Managed Care Contract Specialist

TEAMHEALTH

06.2008 - Current

Focus in the area of Anesthesia contracts and reimbursement
Work close with Manage Care Director, Billing Manager, and Contract Management Supervisor to ensure correct information is up to date in our billing system
Submit fees for new contracts and amended contracts for loading
Contact carriers to acquire accurate fees and contract information for loading and research fee discrepancies
Schedule and take part in quarterly calls with VPO’s
Coordinates financial analysis as requested
Assist in the negotiations and preparation of executed contracts & amendments, and contract reviews
Review & resolve requests from Provider Enrollment
Initial point of contact for UA/OA & billing questions
Provide the necessary documents for Multi-state contracts
Load contracts and supporting documentation into the Contract Management Inventory System
Provide VPOs with participating plans for all anesthesia groups within their assigned service area upon request
Obtains contract packets including contract, physician participation forms, fee schedule, and other Managed Care information pertinent to the credentialing of physicians contracting with the plan
Contact Managed Care Organizations to establish contacts for negotiation and renegotiation purposes
Organize and update the index for VPO’s and the legal department
Initiates discussion and facilitates requests for proposed contracts to be negotiated for Commercial, Exchange, Medicare and Medicaid products
Assist with drafted contracts
Contract Management Specialist
Lead specialist and administrator for anesthesia contracts, billing and support
Obtain and track fee schedule updates, which are scheduled to change according to the terms in the managed care contract
Obtain fee schedule verification due to payment discrepancies
Research and resolve billing issues pertaining to participation status, claim specification requirements and/or fee discrepancies not identified in DMS (Denials Management System)
Support, research, and implement information into the billing system to support the loading for multiple Lines of Business (LOB) such as emergency departments, hospitalists, clinics, anesthesia, as well as specialized contractual billing nationally
Communicates to billing personnel and provider enrollment requirements regarding credentialing, provider numbers and claim specifications
Verify provider numbers for commercial carriers
Work closely with Managed Care and communicates findings / discrepancies with Managed Care and the billing centers
Research and obtain executed and/or supporting documentation of required elements for existing contracts in order to maintain and manage the electronic contract inventory
Communicate with billing personnel, managed care negotiators, and provider enrollment regarding the status of implementing managed care contracts
Participate and prepare for bi-weekly meetings with Managed Care and billing center personnel
Prepare weekly and monthly reports
Mentored and trained new employees
Created new loading policies to prevent double loading.

Summary

Overview

Work History

Style Associate

Managed Care Contract Specialist

Education

Bachelor of Science in Communications, Major in Advertising -

Associate of Science, Marketing -

Skills

References

Timeline

Style Associate

Managed Care Contract Specialist

Bachelor of Science in Communications, Major in Advertising -

Associate of Science, Marketing -

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