Sherry Reed Email and Phone Number

• Perform configuration audits to identify potential coding discrepancies within configuration setup.• Troubleshoot and problem solve contract implementation issues related to system configuration. • Perform root cause analysis, review and analyze data relevant to provider contracts and systems configuration.• Validate claims payment to system configuration against provider contract.• Identify potential areas of process vulnerability through procedure review and report trending/analysis; generate reports for analysis and/or sampling; recommend and implement process changes. As a result of analysis and sampling activity, develop reports detailing the findings and trending results on a monthly basis while also recommending any processing enhancements and/or internal control improvements. • Run reports on claims to be reprocessed, once claims are reprocessed calculate over or under payments.• Review LCA’s and LCD’s to write internal business policies.

Analyze data to determine business problem, trends, or opportunities for process improvements. Work with high profile customers, mentor peers, answer questions and help identify potential discrepancies. Assist with special projects as requested. Perform highly complex benefit coding, analyze, design, and code new clients/groups or products, maintenance of existing groups/products, corporate projects, strategic initiatives, benefit enhancements, and application of medical policy. Provide root cause analysis and corrective action plans. Responsible for verification that the delivered application code meets the customer needs based on the specifications, ensuring minimal defects in both UAT and production. Accountable for identification, documentation, and escalation of risks, defects and issues throughout the project lifecycle. Responsible for assisting in the resolution of risks, defects and issues. For smaller projects or initiatives may be accountable for project schedule and resource allocation.Work with customers, application developers, architects, project management and team members to understand business requirements that drive the analysis and design of quality business solutions. Communicate effectively to explain technical benefits, application of medical policy, and claims processing capabilities and functionality.Work independently or as a team member, to develop benefits and medical policy coding applications/solutions and perform project activity. Provide required business and/or subject matter expertise for both project and production related activities. Research claims processing problems, perform initial problem identification and resolution activities and debug benefits and medical policy program coding. Document the results of problem analysis/research and prepare the specifications necessary to identify impacted claims. Manage job tasks and project requirements so that work is completed on time, in scope, within budget.

Perform highly complex benefit coding, analyze, design, and code new clients/groups or products, maintenance of existing groups/products, corporate projects, strategic initiatives, benefit enhancements, and application of medical policy. Responsible for verification that the delivered application code meets the customer needs based on the specifications, ensuring minimal defects in both UAT and production. Responsible for assisting in the resolution of risks, defects and issues. Work independently or as a team member, to develop benefits and medical policy coding.Research claims processing problems, perform initial problem identification and resolution activities and debug benefits and medical policy program coding. Document the results of problem analysis/research and prepare the specifications necessary to identify impacted claims. Manage job tasks and project requirements so that work is completed on time, in scope, within budget, and with minimal defects.

Work with high profile customers, mentor peers, answer questions and help identify potential discrepancies. Assist with special projects as requested. Analyze, design, and code new clients/groups or products, maintenance of existing groups/products, corporate projects, strategic initiatives, benefit enhancements, and application of medical policy. Work independently or as a team member, to develop benefits and medical policy coding applications/solutions and perform project activity. Provide required business and/or subject matter expertise for both project and production related activities. Research claims processing problems, perform initial problem identification and resolution activities and debug benefits and medical policy program coding. Document the results of problem analysis/research and prepare the specifications necessary to identify impacted claims.Manage job tasks and project requirements so that work is completed on time, in scope, within budget, and with minimal defects. Follow coding structured protocols and maintain coding documentation.

Provide quality auditing for initial claims intake (Data Review, Quality Assurance). Also proficient processing claims, including COB, Orthodontic, Claims Level I, Claims Level II, and Out of Country claims for world’s largest dental processing organization. Consistently meet or exceed quantity and quality production standards. Requested to directly assist the testing team with loading claims manually for new group audits, provider tools, coding audit, COB processing and various Formworks tests. Requested to assist co-workers with questions relating to all areas of claims processing. Skilled in Microsoft Word and Excel as well as Metavance, Macess, and Formworks.

All aspects of owning and operating a daycare.

Processing enrollments, verifying eligibility through the government data base, filing and answering incoming phone calls.