Provider Services

SHERRY SHEEHAN, CPC

*** ******** *****, **. *****, MI 48879

Phone: 517-***-**** / ****************@*****.***

CAREER OBJECTIVE

I’m a positive, take-charge person who has been strongly recognized within my working career, as a leader to get the job done.

EDUCATION AND TRAINING

•Bachelor’s Degree in Business Administration

•Certified Professional Coder

CAREER EXPERIENCE

UNITED HEALTHCARE

Manager, Network Contracting, National Ancillary & Affordability (March 2021-current)

Contracting Ambulatory Surgery Centers by Region to achieve affordable health care for members

Keyperson in building a regional network and the process to complete negotiations and contracting

Managing Surgery Center contracting by Revenue Stream Tiers

Guide Facility on credentialing outcomes following current policy and procedures

Senior Network Account Manager (May 2017 -March 2021)

Contracting Surgery Centers, Urgent Cares, Hospital contract

Liaison to Provider Network issues

Use of many contract systems – including Emptoris, CSP, Navigator, CLM, Amaardi, and many reporting functions

Train the trainer CLM (development, including building the templates specific to state)

Guide provider on credentialing outcomes following current policy and procedures

Participate in Network initiatives for growth and expansion

LANSING COMMUNITY COLLEGE, Lansing, Michigan

Adjunct Instructor (10/2015 – 1/2023)

Teaching students the fundamentals of Billing and Coding, Electronic Health Records

Teaching students the fundamentals of Administrative Medical Assisting

Preparing teaching to meet guidelines of program and learning outcomes

Knowledge of Coding ICD-10, CPT and HCPC’s, using Modifiers and CMS guidelines

MCLAREN PHYSICIANS dba MID MICHIIGAN PHYSICIANS, Lansing, Michigan,

Operations Manager (1/2016 – 3/2017)

Maintain all functional operations, including patient flow, account payable, Day to Day Operations, financial statements

Day to Day operations of Practice, including Hiring, Firing of Practice – Staff of 35 including professional staff

Maintain JCAHO and PCMH standards

Maintain physician records for credentialing compliance. Keep records with carriers’ current for credentialing of 15 provider practice

Lansing Pediatric Associates, Practice Manager (6/2009 – 11/2015)

Day to Day Operations of Practice

Maintained financial statements

Hiring, Firing of Practice staff, managed a staff of 70 employees including professional staff

Hold regular Board Meetings

Building Operations/Maintenance

Maintain all functional operations, including patient flow, billing operations

Primary Business Liaison to Large Multi Physician practice

Fee Schedule Maintenance

Maintain records for credentialing of large multi-functional professional staff

Maintain Patient Centered Home (PCMH) accreditation standards

MCLAREN - INGHAM REGIONAL MEDICAL CENTER, Lansing, Michigan

Practice Administrator for Specialty Clinics (7/2008 – 4/2009)

Day to Day Operations of Practices

Analyze office process for profitability in practices. Maintain corporate compliance and accreditation standards

Strategize future growth opportunities in community and within practice

Hiring, Firing of Practice staff

Develop efficiencies within practice to “work smarter, not harder”

MCLAREN HEALTH PLAN, Flint Michigan

Provider Services Manager (1/2007 – 7/2008)

Day to Day Operations of Provider Services Department

Strategize future growth opportunities in Provider Network

Hiring, Firing of Department staff

Maintain Fee Schedules/build claims payment rules

Develop Department Processes

Outreach quality credentialing outcomes in provider network

BLUE CROSS BLUE SHIELD MICHIGAN, Detroit, Michigan

Auditor/Analyst (2005 – 2007)

Desk Audits

On-Site audits as needed

Medical Record Review

Assist in Coding review

Research system for policy and procedure

MEDICAL SITE REVIEWERS, Lansing, Michigan

Review Project Manager (11/2004 – 8/2005)

HEDIS reviews – including scheduling reviews and abstraction, oversight

Recruiting, Training and maintaining professional staff nationwide

Launch and manage new product lines for review

Project management

PHYSICIANS HEALTH PLAN, Kalamazoo, Michigan

Fee Analyst (2003 – 2004)

Hospital Contract Installation

Interpret and Implement Medicaid Policy

Determine Fee schedule/Implementation of levels of reimbursement per site of service

Liaison to State of Michigan for Three Health Plans

Coding resource for Health Plans

Ongoing education to staff at three sites on correct coding policy, Medicaid Bulletins and protocols

COMMUNITY CHOICE MICHIGAN, Okemos, Michigan

Provider Relations Representative/Claims Liaison/Operations Lead (1996 – 2003)

Contracting/Network Development – Professional, Hospital and Ancillary

Project Manager/Client Services Supervisor/Operations Lead

Overall go to person to operationalize policy and procedures for Health Plan

Account Manager – Professional, Hospital and Ancillary. Maintained staff to support account management with assigned territories

Maintain current statewide contracts

Claims Payment Liaison/Maintain Fee Schedule

Health Plan Liaison/Health Plan Coder

Development of Policy and Procedure for Billing to Health Plan

Education to Provider Network and Corporate staff of Billing Policy – for HCFA 1500 and UB-92 Claims

Maintain quality stands for network, Active participant for HEDIS and Encounter Data Reporting

Appeal committee representative, Chairperson for Employee Suggestion Committee

Served as key person to actively establish work plans for reimbursement outcomes

Trainer for – Customer Service Module, UB-92 Claims processing and HCFA 1500 Claims processing

REFERENCES PROVIDED UPON REQUEST

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