ALISON REBECCA SIPE

• Partnered with internal and external stakeholders to identify, anticipate and address provider reimbursement issues and implemented updates/changes based on solutions generated to address the issues.
• Identified payers and providers that require access and/or reimbursement education and support regarding Cerapedics’ products.
• Provided coverage, coding, and reimbursement information to key account staff members (i.e., practice manager, nursing, billing, and reimbursement staff) to appropriately support i-FACTOR approval and payment.
• Collaborated with Commercial and Medical Affairs teams to compliantly share insights into customer needs, potential access and reimbursement barriers, and payer coverage issues/opportunities impacting access at sites of-care.
• Led cross-functional teams to achieve project goals, fostering collaboration and innovation between Medical Education, Clinical Affairs, Legal & Compliance, Sales Operations and Strategic Accounts.
• Closely monitored industry updates with an emphasis on prompt communication/explanation of payer coverage policies (and any changes impacting access positively or negatively) to internal and external stakeholders in a timely manner.
• Tracked patient access barriers to care (specifically provider and/or facility level payer denials and the subsequent appeals process) to secure approval for i-FACTOR.
• Built a tracking and resolution system for market access issues which was seamlessly integrated into Cerapedics' CRM; greatly increasing the efficiency and accountability for rapid issue resolution. Developed detailed, real-time analytic reports that were presented to the C-Suite on a monthly basis.
• Proactively communicated i-FACTOR access and reimbursement services and appeal programs, policies, procedures, and resources so stakeholders are fluent in how to use programs and systems.
• Conducted quarterly reviews with the Commercial team (internal sales and distributorship partners) on their account's utilization of Cerapedics' reimbursement support services to better understand how we may evolve our offering to best suit the needs of accounts.
• Developed and maintained the creation of region specific and payer-specific reimbursement collateral, tools and resources.
• Performed Health Economics and Outcomes Research (HEOR) evaluation of literature, real world outcomes and clinical needs assessments as they relate to Cerapedics' products and payer healthcare policies.
• Contributed to the writing, review, and publication of, AMCP Dossiers and Value Analysis Committee Compendiums for Cerapedics' products.
• Integral member of the New Technology Add-on Payment (NTAP) team, serving as project management and communications lead to ensure timely and complete application submission for FY25.

Managed various projects for a rapidly growing medical device start up company.

• Designed, evaluated and modified reimbursement policies to keep clinic billing and coding support current, competitive and in compliance with current HHS guidelines across all CMS jurisdictions. Specifically, for usage and reimbursement for services performed in conjunction with a 510(K) pre-market clearance medical device as an adjunct therapy in Podiatry clinics.
• Collaborated with external reimbursement firms to create a comprehensive reimbursement guide for clinic distribution as well as long term strategic analysis for CPT 97610 reimbursement in both the public and private payor sectors.
• Assisted in successfully assigning CPT 97610 as the exclusive code assigned to Vaporous Hyperoxia Therapy by CMS and the APMA as "an FDA-cleared technology that provides low frequency, non-contact, non-thermal ultrasound, delivering continuous healing to the wound bed."
• Oversaw packaging of treatment supplies and medical devices for delivery and arrival to clinic sites in CO, AZ and TX. Coordinated extensively with the Colorado engineering office and receiving clinics to ensure smooth deliveries for new clinic launch sites as well as returns to main engineering office.
• Responsible for purchasing biomedical engineering R&M, V&V and production supplies for prototype builds, current device functionality maintenance and treatment supplies for clinic distribution.
• Completed annual FDA Medical Device Establishment, Registration, User Fees and Small Business Decisions for 510(K) registration compliance.
• Completed annual CMS Open Payments reporting in adherence to HHS guidelines under the Code of Federal Regulations Sunshine Act (78 FR 9521).
• Monitored and recorded regulatory compliance with processes, policies, procedures and standards in regards to maintenance, functionality, safety and efficacy of medical devices as well as distribution of treatment supplies to contracted clinics.
• Transcribed minutes of meetings and executed meetings and events for company to support sales, business development and senior management teams.
• Processed travel expenses and reimbursements for executive team and senior management group. Reconciled expenses into comprehensive expense reports for CEO, CFO and CPO budget analysis on a monthly basis.
• Managed payroll data entry, identification of reporting errors and payroll and/or invoice processing for 16 employees and independent contractors.

Responsible for supervising the day-to-day management of the Revenue Management regulatory insurance follow-up team, including but not limited to: financial counseling, patient registration, billing, denials, appeals, payment posting and reporting.

Monitores the regulatory insurance follow-up operations and assesses representative's correspondence, system note lines, performance and application of guidelines and procedures in accordance with federal and state regulatory reimbursement standards.

Performs performance appraisals and quality evaluation of staff, delivering disciplinary actions as necessary for the purpose of developing and maintaining an efficient staff.

Provides operational management of the department including understanding, monitoring and improving work-flow and processes as related to the regulatory insurance payor sector of accounts receivable. Participates in decision making concerning policies, procedures and equipment. Assists in writing and implementation of new policies and procedures. Oversees, monitors and approves staff schedules and payroll in Kronos.

Serves as resident technical resource to all areas of accountability. Serves as point of contact in collaborating of payor relations, specifically as the liaison between Center Health Revenue Management and the Colorado Department of Health Care Policy and Financing.

Partners with other revenue management areas and facilities to achieve accounts receivable resolution, with an emphasis on remaining current with departmental and payor changes in order to provide the most current information to Centura's patients and achieving account resolution.

Develops and implements strategies surrounding specific audited reports ensuring compliance, financial viability and continued improvement of regulatory insurance accounts receivable.

Coordinates and organizes work functions within assigned departmental areas, working collaboratively with international and external vendors, communicating needs and developing solutions to problems ensuring departmental and organizational targets are met and/or exceeded.

Ensures processing of patient accounts for accuracy, timeliness and compliance enabling staff productivity to meet/exceed benchmarks.

Coordinates and conducts staff meetings, payor meetings and other management related meetings, ultilizing time management and efficiencies to make the most of resource usage.

Provides communication related to change in practice and regulation, monitors impact of change, and develops strategies to improve revenue performance. Identifies technical training and personal development training opportunities for staff and leaders.

Maintains an environment that selects, hires, develops and coaches staff, builds good teamwork, encourages retention and employee satisfaction. Possesses a strong working relationship with Human Resources in staff hiring, disciplinary action and termination of employment.

Successfully received over $1 Billion in outstanding receivable payments from regulatory payors to Center Health.

• Supervises all aspects of chart completion, referrals and authorizations for both Professional and Hospital services and charges as applicable to claims reimbursement.
• Utilizes a multi-disciplinary approach to ensure proper measures have been taken to optimize charge capture and maximize claim compensation.
• Provides guidance and continuing education for clinic supervisors, office specialist staff and clinical providers in regards to coding, billing and claim processes.
• In charge of utilizing in-depth knowledge of insurance plans, coverages and billing procedures related to Specialty Medicine.
• Solely responsible for efficient and timely filing for all PB and HB claims submitted on behalf of the Mountain and North Denver Operating Group (MNDOG) Neuroscience and Spine clinics.
• Serves as a point of contact to facilitate transparent communications between the clinical staff; including Neurologists, Neuro Surgeons, Neuro Psychologists, Neuro Interventional Radiologists and Advanced Practice Providers with the administrative staff; including executive leadership, office staff, central billing office, finance department, accounts receivable and accounts payable.
• Directly oversees the implementation of compliance practices to align all billing and coding with federal CMS guidelines within our clinics.
• Supports these implementations in conjunction with the Centura Health coding department.
• Follows a strict adherence to coding policies based on coding conventions defined in the American Medical Association's CPT Manual, national and local policies and NCCI Edits, coding guidelines developed by national societies, analysis of standard medical and surgical practices, and a review of current coding practices.
• Facilitates the appeal process for all claim denials received for MNDOG CHPG Neuroscience and Spine clinics; encompassing five distinct sub-categories of specificity and locality.
• Obtains pertinent medical records, referrals, authorizations and letters of medical necessity to formally appeal coverage and eligibility determinations made by insurance companies on behalf of our patients and our practice.
• Has facilitated the return of $218,046 in won claim appeals for Quarter 1, Fiscal Year 2017.
• Clinic liaison to patients and their families in regards to billing questions, concerns and grievances.
• Assists patients in insurance coverage knowledge, estimated costs of visits and procedures and implementation of payment plans if applicable.
• Directs patients to appropriate resources for all financial and insurance coverage concerning both acute treatment and chronic care through our practice.
• Provides genuine care, concern and compassion to resolve patients' expression of dissatisfaction and offers prompt, concise and fair resolutions.
• Clinic liaison to attorneys in the facilitation of all aspects of legal participation of our medical providers in depositions, subpoenas and testimonies in accordance with Centura Health Risk Management policies and procedures.
• Lead correspondence coordinator between Centura Health finance department and clinic providers in regards to wRVU (relative value unit) compensation.
• Investigates any discrepancies in reporting measures to ensure current ad correct compensation is conveyed through charge reconciliations and posted charges for both Catholic Health Initiatives (CHI) and Avista Health Systems (AHS) billing centers and associated health care providers.
• Performs detailed daily, weekly and monthly data performance analysis for intricate aspects of associate work conduct; included but not limited to: patient perception analytics through interpretation of Press Ganey quarterly scoresheet; goal monitoring charts, pivot tables and spreadsheet analytics for associate job role speed, teamwork and efficiency; provider patient load by procedure type, count, diagnosis and associated wRVUs to analyze clinic productivity and growth opportunities.
• Currently holds an EPIC Super User Certification for Medical Information Technology and is currently working towards earning a Microsoft Office Specialist and Certification.

• In charge of handling all aspects of patient's charts in the Emergency Department of Saint Anthony Hospital; including but not limited to: collecting accurate and up to date demographic information, quick and precise input of said information, utilizing systems to send appropriate billing to insurance companies while providing superior customer service to all patients.
• In charge of utilizing in-depth knowledge of insurance plans, coverages and billing procedures related to Emergency Medicine.
• In charge of meeting and exceeding specific quotas for co-pay, co-insurance and deductible collections on a daily, weekly, monthly and quarterly basis.
• Possess a superior knowledge of medical classifications pertinent to a Level 1 Trauma Center and Flight For Life Headquarters.
• Serves as a team-leader within the department; serving on multiple committees and assisting employees with on-the-job training and continuing education.
• Meticulous attention to detail in all patients charts and fixing errors made within the department on said charts.
• In compliance and very familiar with all OSHA, Joint Commission, Infection Protection and all protocols involved with patient and employee safety.

• Successfully managed budgets and allocated resources to maximize productivity and profitability.
• Conducted regular performance evaluations for 130 direct reports, offering constructive feedback and facilitating professional development opportunities.
• Resolved escalated customer complaints professionally, turning potentially negative experiences into opportunities for continued patronage.