Summary
Overview
Work History
Education
Skills
Technical Skills
Timeline
Generic

Sherry Martinelli

Denver,CO

Summary

Offering a solid foundation in revenue cycle processes, including billing and claims management. Utilizes analytical skills to identify and resolve discrepancies efficiently. Seeking to transition into a new role where these transferrable skills can be used to further my career within the healthcare industry.


Overview

26
26
years of professional experience

Work History

Hospital Billing Specialist II / Claims Processor

Intermountain Healthcare
10.2022 - 12.2024
  • Provided training to new hires, addressed team questions, and assisted leadership when needed.
  • Enhanced accuracy with verification of billing information and documentation.
  • Improved customer satisfaction by addressing billing inquiries and resolving issues promptly.
  • Worked effectively with medical payers such as Medicare, Medicaid, and commercial insurances to obtain timely and accurate payments.
  • Worked with multiple departments to check proper billing information.
  • Researched and resolved billing discrepancies to enable accurate billing.
  • Provided training to new hires, addressed team questions, and assisted leadership when required.
  • Collaborated with insurance companies to ensure accurate reimbursements for hospital services rendered.
  • Reviewed payment discrepancies and denials, ensuring resolution within timely guidelines.
  • Collaborated with insurance companies during meetings to address and resolve claim issues.
  • Re-billed claims due to coding changes, late charges, or other necessary corrections.

Hospital Billing / Claims Processor Team Lead

SCL Healthcare
04.2019 - 10.2022
  • Managed accounts for various insurance payers, including Medicare Advantage, Medicaid, Veterans Affairs, Indian Health Service, Hospice, and Skilled Nursing Facilities.
  • Facilitated team meetings to address claim-related questions and determine next steps.
  • Escalate accounts to provider representatives via working sessions and/or JOC
  • Reviewed team accounts for quality assurance and documented findings on spreadsheets for supervisor review.
  • Sent weekly production numbers to team members, supervisor, and manager.
  • Reviewed high-dollar AR accounts for monthly call to discuss with leadership.
  • Coordinated with various departments to address and resolve account discrepancies.
  • Assisted leadership in various other duties as needed.

Hospital Billing Specialist II / Claims Processor

SCL Healthcare
01.2012 - 04.2019
  • Follow up on claim status, appeals, medical record requests
  • Work on correspondence, coverage change requests, hospice reviews, and customer service inquiries.
  • Worked on Topeka/Ardent accounts and West Pines Behavioral Health accounts for Medicare Advantage, Tricare and Veterans Affairs.
  • Assist in training new hires, answer questions from the team, and support the lead, supervisor, and manager when needed.
  • Work on compliance audit rebills
  • Reviewed SNF and Hospice coverage, billing, and follow-up.
  • Handle various projects needed to assist the supervisor and/or management
  • Responded to calls, emails, and faxes to address inquiries and provide necessary information.

ER Registration

North Suburban Medical Center
01.2009 - 01.2012
  • Registered patients by verifying demographics, employment, contact, and insurance information
  • Responded to ambulance and police arrivals promptly to obtain as much information as possible
  • During overnight shifts, responsibilities also included working orders for patients being admitted to observation or inpatient.
  • Entered information on newborns, admitting patients upon arrival for sleep studies, labor and delivery, and scheduled procedures.
  • Worked ABN report and meet with Medicare patients to get required signatures after being admitted.

Kaiser & HealthNet Insurance Recovery

Accenture
01.2007 - 01.2009
  • Audited Kaiser and HealthNet claims to find potential recoveries on paid claims such as Coordination of Benefits, Ambulance claims, Mom & Baby, etc

Commercial Hospital Billing Team Lead

HCA - HealthONE LLC
01.1999 - 01.2007
  • Follow up on claim insurance for outstanding accounts
  • Appealed accounts when denied or underpaid and followed up with insurance.
  • Created Special Program Indicator reports/spreadsheets for underpaid accounts related to contract issues.
  • Approved refund and adjustment requests by end of the month.
  • Prepared agenda and spreadsheets for monthly meetings with Great West Healthcare.
  • Trained team members and assisted them with claims or job duties.
  • Worked one-on-one with Great West provider representatives to resolve issues with contracts, payments, or denied claims.
  • Assisted supervisor with other tasks as needed

Education

Diploma -

Northglenn High School
Northglenn, CO
01.1995

Skills

  • Healthcare revenue cycle
  • Self-motivated, proactive and goal oriented
  • Insurance knowledge
  • Problem solving and attention to detail
  • Teamwork and collaboration
  • Insurance Follow-up and claim submission
  • Adaptability
  • Workload prioritization
  • Denial management, appeals and timely filing guidelines

Technical Skills

  • Systems: Epic, OnBase, Excel, Microsoft 360, Microsoft Teams, RightFax, DDE, RTE
  • Insurance Provider Portals: Affilite Link, Availity, UHC Link, OneHealth Port, Noridian, CMS web pricer, CO Medicaid, Vitalware.

Timeline

Hospital Billing Specialist II / Claims Processor

Intermountain Healthcare
10.2022 - 12.2024

Hospital Billing / Claims Processor Team Lead

SCL Healthcare
04.2019 - 10.2022

Hospital Billing Specialist II / Claims Processor

SCL Healthcare
01.2012 - 04.2019

ER Registration

North Suburban Medical Center
01.2009 - 01.2012

Kaiser & HealthNet Insurance Recovery

Accenture
01.2007 - 01.2009

Commercial Hospital Billing Team Lead

HCA - HealthONE LLC
01.1999 - 01.2007

Diploma -

Northglenn High School

Similar Profiles

CREATE PROFILE
Sherry Martinelli