Shelley Sheets Email & Phone Number

Oklahoma City, Oklahoma Area

Worked with systems and BAs to define the requirements and functional specifications to reflect the process requested by operations for quarterly/monthly releases. Participated in JAD meeting and assisted with design of new projects to obtain the least impact to production. Prepared documentation to notify management of pending changes in order for training and internal SOPs to be updated in a timely manner. Participated in UAT and return to service testing when applicable. Follow up all implemented changes with Post Implementation Review to report any negative effects to systems and operational procedures.

Oklahoma City, Oklahoma Area

Responsible for the seamless integration of business core values as well as effective alignment of processes and procedures to support goals and objectives of the project:• Development of communication plans to introduce changes, coach managers and supervisors to effectively manage changes.• Ensure appropriate vetting, documentation, and implementation of changes. • Participated in the transition to a new system (BCRS) by helping with design of the system to provide a flow for processing Group Health Plan (GHP) and Non-Group Health Plan (NGHP) workload. • Conduct research and analysis to ensure changes meet or exceed program goals and facilitates impact mitigation efforts.• Uses logic and reasoning to identify the strengths and weakness of alternative solutions, conclusions or approaches to problems.• Manages relevant employees by delegating tasks on the project to employees best positioned to complete them and setting deadlines.• Serves as a point of contact for teams when multiple units are assigned to the same project to ensure team actions remain in synergy.• Maintain communication with company executives about the status of the project, ensuring projects stay on track and on budget and adjusting if necessary to meet new requirements.• Manages the oversight of the imaging sub-contractor.

Oklahoma City, Oklahoma Area

Maintain and manage internal standard operating procedures to be compliant with the CMS guidelines and updates due to changes and technical directives from CMS:• Provided technical expertise and guidance to ensure compliance with all applicable statues, regulations, and CMS policy. Reviewed and implemented changes to internal processes in order to comply with policy guidelines related to MSP Recovery work performed under the contract.• Managed all standard operating procedures changes and outgoing correspondence and participated in major functional user groups to ensure full compliance with CMS guidelines and the contract statement of work.• Actively communicated with the training staff, operations, and the compliance officer to ensure organization-wide procedural uniformity.• Handled timely updates of internal processes per Technical Directive Letters, Joint Service Agreements, and CMS Change Requests.

Oklahoma City, Oklahoma Area

• Initiated recovery of mistaken payments in accordance with MSP laws and responsible for ensuring payments/adjustments of claims have occurred.• Research complex claim data and defenses submitted by insurers to justify responsibility of overpayment to Medicare.• Updated the Common Working File (CWF) via Electronic Correspondence Referral System (ECRS) when changes in beneficiary MSP status were identified to facilitate pre-payment savings.• Responsible for the GHP Gold Service for the contractor, which consists of reporting system issues, notification to management of areas for training, quality of correspondence generated through calls from the insurer or the employer.

Topeka, Kansas, United States

• Updated the Medicare operating system with required changes accurately and timely. • Reviewed CMS change requests for possible system and desk procedure updates.• Reviewed edits and audits in the Medicare operating system to locate inefficiencies. Submitted system maintenance requests when needed.• Performed system testing to ensure system continuity and to report issued identified.• Conversion of MSP data for the transition to the MCS System at BCBS of Kansas. • Assisted in preparation of quarterly reports to CMS and also resolution of Accounts Receivables.