Sherry L. Pelo

**** * ***** ***., *******, WA ***07

509-***-**** (Mobile)

adylx6@r.postjobfree.com

www.linkedin.com/in/sherrypelo-840a9271

Top performing experienced worker in the Healthcare Industry in Reimbursement Cycle Management, Provider Credentialing, Medical Billing, Payment Resolution, Referral and Authorization Management, Ensuring compliance with Organizational and Regulatory Policies and Procedures.

Contracted and credentialed health care providers for a 5-county area

Credentialed and re-credentialed all professional providers for Kaiser for 3 years.

Medical billing and AR for 5 years to state, federal, L&I, and commercial payers

Obtained Referrals and Authorizations for 8 to insure top reimbursements.

Specialized in outpatient rehabilitation, behavioral health, and autism.

Credentialed providers for Accreditation Association for Ambulatory Health Care for 2 years

Expert with insurance websites, obtaining benefits, copay, deductibles, coins.

Experience registering and scheduling patients for over 15 therapists.

Experience with worker’s compensation, and third-party billing.

Six years of Epic experience.

Multicare

Registrar

Using Epic registered patients coming in for surgery, GI procedures, PET scans, MRIs, etc.,

ensuring all information on file was correct, including insurance verification, and collections of prepay amounts for services.

April 2023 to July 2023

Lighthouse Physical Therapy and Sports Medicine

Temporary position

Authorizations Specialist

Obtained initial and reauthorizations for patients in need of physical therapy.

Using online insurance websites, verifying benefits, obtaining authorizations.

February 13 to March 13, 2023

Green Thumb Reimbursement Management

Remote position as Company is in New Jersey

Authorization Representative

Obtained authorizations for four different contracted provider offices for PT, OT, ST, and ABA services using 4 different EMR’s.

May 2022 – November 2022

Sherry L. Pelo

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Lilac Behavioral Health Services

318 E. Rowan Avenue, Suite 201

Spokane, WA 99207

Billing Manager

Billed all ABA services using Central Reach and worked AR. They brought in a new CFO in December, and he decided to restructure the department.

October 2021 to December 2021

Community Link Consultants

23905 E. Wellesley Avenue

Otis Orchards, WA 99027

Used Athena to complete FQHC billing for company clients.

May 2021 – October 2021

St. Luke's Rehabilitation Institute

Admitting/Authorizations Representative/Referrals Management

October 2015 – July 17, 2020

Performed patient scheduling for 15 therapists, pre-registration, and obtained authorization/verification of benefits in a fast paced, ever-changing environment. I was very successful with cultivating working relationships between Therapists, Practitioners, and Patients.

PAML

Billing Specialist

June 2015 - October 2015

(Temp position through Spherion)

Spokane, WA

Billed all DSHS secondary claims to DSHS.

Spherion - Cancer Care Northwest

Authorization Triage

I used various third-party online organizations to obtain authorizations for outgoing referrals for CT's, MRI's, U/S, etc.

Spokane, WA

October 2014 to January 2015

Sherry L. Pelo

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Embassy Management, LLC

Credentialing/Billing Specialist

March 2013 - March 2014

Spokane, WA

I was responsible for all contracting and credentialing for Imagine Behavioral & Developmental Services with insurance companies to provide ABA (Applied Behavior Analysis) services to children diagnosed with Autism or autism spectrum disorder. I also obtained all authorizations/approvals from insurance companies for all therapists. Worked directly with staff (ABA counselors and BCBA's) to ensure proper coding and completion of appropriate insurance authorization forms.

Providence Physicians Clinic

AR Billing Specialist

October 2012 - March 2013

Spokane, WA

(Temp job through Spherion)

I worked to close out the books on the old and current claims before the billing process was moved to Providence's Physicians Clinic new office in Liberty Lake. We brought in over $50,000 of old AR while I was there.

Summa Health System

Medicare Enrollment Specialist

May 2012 - October 2012

Akron, Ohio

(Temp job through Robert Half)

Working (MSP) Medicare Secondary Payer Reports, (COB) Coordination of Benefits Reports, (OHI) and other Insurance Primary Reports all downloaded from the Medicare Website. Updating Summa Care’s software for Customer Service, Membership, Claims Processing, Authorizations and Medical Management, Provider Base, Benefits/Pricing Management, Billing/ Accounts Receivable.

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