Chris Duncan Email & Phone Number

Zionsville, Indiana, United States

Zionsville, In

+ Provided direct supervision, leadership, and team building for the Kentucky Medicaid Services (KMS) Surveillance and Utilization Review Systems (SURS) staff in Kentucky and Indiana.+ Ensured that contract deliverables were completed on time. This included bi-weekly, monthly, and quarterly reports. Additionally, aided in the creation of the SURS operations manual and updated the manual on a quarterly basis.+ Created Microsoft Excel spreadsheets designed to analyze provider billing patterns to replace the malfunctioning Decision Support System (DSS) profiler that was provided by another contractor.+ Developed an education and training program for the Department for Medicaid Services (DMS) Program Integrity (PI) staff, Office of the Inspector General (OIG), Kentucky Medicaid Fraud Control Unit (KMFCU), and Commonwealth contractors in the identification and auditing of Medicaid providers.

+ Provided direct supervision, leadership, and team building for the Program Integrity (PI), Claims Analysis and Recovery (CAR), and SUR Research staff.+ Ensured that contract deliverables were completed on time. This included monthly, quarterly, and yearly reports from PI, CAR, and Surveillance and Utilization Review (SUR) research sections of the SUR contract. Additionally, updated the CAR operations manual with current policy and procedures on a monthly basis as required by the SUR contract.+ Supervised the selection of Indiana Health Care Programs (IHCP) providers for review by the PI staff to ensure that the yearly audit plan goals are met. Tracking the provider through the research process until approved for audit or closure.+ Identified IHCP billing system vulnerabilities, made recommendations to the state for changes to policy and the billing system to eliminate the identified system vulnerabilities.+ Supervised the CAR staff in identifying the potential loss to the IHCP due to system vulnerabilities, identifying overpayments to IHCP providers, and the recovery of those funds.

+ Conducted both on-site and medical record audits of Indiana Health Coverage Program (IHCP) providers.+ Created case briefs and outlines for Program Integrity (PI) and Indiana Medicaid Fraud Control Unit (IMFCU). + Liaison between the surveillance and utilization review department and Indiana School Corporations Medicaid Committees.

+ Provided excellent customer service to State Farm policy holders, claimants, service providers, and other insurance companies while maintaining State Farm’s commitment to fair claim practices.

Mba

Activities and Societies: Oklahoma Athletic Trainer's AssociationI was a graduate assistant athletic trainer while I completed my master's.

Bachelors Of Science, Athletic Training

Activities and Societies: Ball State Student Athletic Training SocietyReceived the Presidential Scholarship 1994 through 1998 Received.