Summary
Overview
Work History
Education
Skills
Timeline
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Sharon O'Grady

Santa Rosa

Summary

Results-driven Denials Specialist at Providence Health & Services with expertise in claim analysis and denial resolution. Proven ability to enhance payment accuracy and streamline processes through effective communication and data analysis. Skilled in navigating payer portals and maintaining compliance, contributing to improved reimbursement outcomes.

Overview

21
21
years of professional experience

Work History

Denials Specialist

Providence Health & Services
Santa Rosa
09.2022 - 07.2024
  • Analyzed assigned accounts for denial trends.
  • Worked closely with support departments (coding, billing, case management) to resolve denials and resubmit billing.
  • Reported denial trends to the supervisor.
  • Submitted necessary documents and appeals to commercial payers via online payer portals in order to facilitate claim payment.
  • Identified areas for improvement for the denials team.

Reimbursement Analyst

St Joseph Health
Santa Rosa
11.2006 - 08.2022
  • Reviewed incoming payments from commercial carriers for payment accuracy for both inpatient and outpatient hospital claims.
  • Forwarded denial issues to the denial follow-up team for resolution.
  • Submitted payment disputes for accounts with contractual reimbursement discrepancies.
  • Reported ongoing denial issues to the team and supervisor.
  • Evaluated provider contracts to ensure compliance with current laws and regulations.
  • Participated in meetings with department heads concerning reimbursement policies and procedures.
  • Maintained confidentiality and integrity of patient data
  • Corrected account balances to accurately reflect patient vs. Payer responsibility.

Insurance Follow up

St Joseph Health
Santa Rosa
10.2003 - 10.2006
  • Identified and resolved discrepancies between submitted claims and insurance carriers' responses.
  • Collaborated with other departments within the organization to ensure all deadlines are met for timely submission of claims.
  • Communicated with clients regarding their account balances and payment arrangements.
  • Processed credit card payments over the phone using secure encryption technology.
  • Called insurance companies to follow-up on unpaid or rejected claims.
  • Processed appeals when necessary by gathering additional supporting documentation.
  • Responded promptly to customer inquiries via phone, email, or mail regarding claim status updates.
  • Worked closely with team members across multiple departments in order to resolve complex issues quickly.
  • Assisted in training new staff members on insurance verification processes.
  • Participated in regular meetings with management teams in order to discuss current challenges and strategies for improvement.

Education

High School Diploma -

Montgomery High School
Santa Rosa
06-1989

Skills

  • Claim analysis
  • Denial resolution
  • Payer portal navigation
  • Attention to detail
  • Payment reconciliation
  • Effective communication
  • Data analysis
  • Epic, Meditech, Excel, Word

Timeline

Denials Specialist

Providence Health & Services
09.2022 - 07.2024

Reimbursement Analyst

St Joseph Health
11.2006 - 08.2022

Insurance Follow up

St Joseph Health
10.2003 - 10.2006

High School Diploma -

Montgomery High School

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Sharon O'Grady