Shari Chambers Email and Phone Number

Audit claims for recovery, potential fraud or abusive coding. Identify coding trends and patterns. Evaluate claims from clinical and coding standpoint. Research and implement regulatory coding changes as they relate to billing compliance. Apply knowledge of CPT-4/ICD-9 coding guidelines to audit provider claims. Apply knowledge of APC and DRG reimbursement methodology for facilities and National Correct Coding policies.* Audit provider records for potential upcoding, unbundling and unusual billing patterns.Daily use of fraud and abuse software system to identify providers with aberrant coding and billing behaviorAudit physician, facility, ambulance, home health and DME claims.Audit claims from clinical and coding perspective, i.e. appropriate medications, dosage, diagnosis and frequency of treatment, units, quantities, procedures and diagnosis coding.Complete monthly financial report of company savings.Sorbanne-Oxley Audits Aging reports Updating staff on Medicare guidelines Training of new staff and additional training with current staff Working closely with Provider relations to ensure correct coding and payments to providers. Review of medical records to determine correct coding and reimbursement.

Creating Policy and ProceduresTraining of new examinersUpdating fee schedules from MedicareKeeping up with current Medicare guidelines Auditing of provider claims for accuracy and billing according to CMS guidelinesProvider refundsReports on Virtual Examiner system to audit bundling and unbundling issuesWorking with providers on billing issues.Supervising a staff of AuditorsReports to finance on Accuracy of examiner processing and refund informationCreating a training manual for new examinersEducating providers on CCI edits and proper codingPayroll and Vacation/Sick time

Loading and updating provider records.Resolving issues that cause pended claims.Running reports for aging and status.Contacting Providers for updated informationResolving fee schedule issuesSupervising a staff and handling HR responsibilities PayrollTroubleshooting system issues

Claims supervisor for Physician Network Management

Supervised a staff of five examiners.Supervised two customer service representativesMonitored the processing of claimsTrained new employees on claims systems and health plan contractsSpecial projects for administratorsAudited claims for payment accuracyWrote and ran reports on Crystal report serverResolved customer service issues.Entered provider contracts, benefits and fee schedules in system.Processed refunds.Created auditing and claims policy manualsProficient in EZCap, HSD software, Excel and Microsoft Word

Processed claims for both Medicare and CommercialIPA/IPOD claims