Sharan Payton
Shepherdsville
Summary
Dedicated and results driven healthcare administration professional with 15+ years of experience in pharmacy operations, billing, auditing, and claims management. Skilled in improving workflows, developing training programs and ensuring compliance with state and federal regulations. Recognized for strong problem-solving abilities, excellent communication, and the ability to optimize team performance in fast paced environments.
Overview
18
18
years of professional experience
Work History
Program Coordinator
Cencora
Brooks
04.2019 - Current
- Lead departmental projects to monitor productivity, track performance metrics and align goals with organizational strategy.
- Responsible for overseeing associates, managing projects, and ensuring effective communication, quality and customer service operations.
- Develop standard operating procedures (SOP’s) to simplify processes and enhance pharmacy operations.
- Prepare training programs verifying and resolving compliance issues and supporting customer service activities.
- Manage enrolling and assisting patients in applying for patient assistance programs.
- Assist with completing necessary documentation from patients, providers, and insurance companies to obtain approval for medication assistance.
- Work with medical and pharmacy associates to resolve issues related to medication access.
- Comply with state and federal law including HIPAA.
- Analyze reports of medication errors and adverse drug events; implement corrective actions to reduce risk and improve patient safety.
- Adhere to clinical and specialty pharmacy programs and policies.
- Support daily operations by resolving scheduling and resource allocation challenges.
Billing Analyst
Norton Healthcare
Louisville
08.2016 - 04.2019
- Conducted detailed review of CPT, ICD and HCPCS codes to ensure accurate claims submission to the appropriate payer.
- Analyzed and reviewed claims to ensure compliance with payor specific requirements.
- Investigated and resolved claims with insurance denials, claim rejections, and payment posting issues.
- Followed up on outstanding claims using billing and collection skills to resolve outstanding balances.
- Processed and submitted claims to Medicare, Medicaid and commercial payers.
- Partnered with providers and insurance companies to minimize discrepancies and insure timely reimbursement.
Revenue & Billing Specialist - Appeals
Labcorp
Louisville
08.2012 - 08.2016
- Researched and resolved denials on unpaid claims, submitted appeals and corrections as needed.
- Read and interpreted remittance advice and EOB’s.
- Resolved complex denials, contacted carriers and clients when necessary to ensure accurate patient billing.
- Prepared, reviewed and sent patient statements.
- Conducted audits for coordination of benefits ensuring accurate payer responsibility, verified patient insurance coverage.
- Prepared and submitted electronic and paper claims, performed research and resolution of suspended and unbillable claims.
- Worked third party aging reports, performed various collection activities such as contacting patients, sites and third-party payers.
Medical Claims Auditor
The Rawlings Group
La Grange
01.2008 - 08.2012
- Audited medical claims on behalf of health plans, identifying overpayments by verifying benefit determination accuracy and recovered funds.
- Communicated with Medicare, Medicaid, healthcare providers, employers, members and insurance companies to resolve incorrectly paid claims due to coordination of benefit error.
- Processed and submitted claims to Medicare, Medicaid and commercial payers.
- Partnered with providers and insurance companies to minimize discrepancies and insure timely reimbursement.
- Ensured confidentiality and secured all data according to HIPAA laws and regulations.
- Investigated complex billing anomalies and applied coding expertise to detect additional errors and ensure regulatory compliance.
Education
Bachelor of Science - Business Administration
Sullivan University
Louisville, KYSkills
- Healthcare Administration
- Pharmacy Operations
- Medical Billing
- Claims Management
- Process Improvement
- SOP Development
- Training
- Staff Development
- Regulatory Compliance
- Insurance Denials
- Appeals
- Data Analysis
- Reporting
Timeline
Program Coordinator
Cencora
04.2019 - Current
Billing Analyst
Norton Healthcare
08.2016 - 04.2019
Revenue & Billing Specialist - Appeals
Labcorp
08.2012 - 08.2016
Medical Claims Auditor
The Rawlings Group
01.2008 - 08.2012
Bachelor of Science - Business Administration
Sullivan University