Billing Specialist Customer Service
Resume:
Sherry L. Pelo
**** * ***** ***., *******, WA ***07
509-***-**** (Mobile)
**************@*****.***
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
Page Two
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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