Cherry Saunders, MBA, MHA

● Handled special requests for release of information, such as for CMS, payers or Court Orders and supported these escalated issues to specified managers for review and processing. ● Assisted providers in telehealth options to accommodate their patients. ● Lead Compliance Audits to ensure all staff that performs medical record functions do so according to BHN, State and Federal regulations. ● Participated in efforts focused on quality assurance and improvement consulting with program staff to develop a Corrective Action Plan (CAP) in response to identified findings of non-compliance with agency or regulatory standards. ● Provided Medical Intake verification for prior authorization status ● Assisted in handling Provider and Member calls to verify prior authorization and quote of medical benefits ● Utilized various systems to determine individual reimbursement rates from various performance guaranteed groups, small groups and individuals ● Provides assistance to the staff in implementing the CAP. This included planning and conducting trainings, and identifying additional resources for the staff to implement the plan conducting follow-up visits to sites as needed. ● Worked on following clients: Cascade Medical Group, Oregon Medical Group, Greenfield Medical Group, Providence Medical Group, Mt. Sinai, BRPO, Gramercy Medical Group.

● Lead offshore coordination, training & standardization of Consent and Authorization forms in both the electronic and manual release of information. Claims Auditing Experience. ● Managed the training and workflow process for the installation of iKnowMed EHR, and Lynx Mobile in a physician practice/multiple sites, based on the specific workflow determined by the project team. ● Analyzed and redesigned workflow to ensure the maximum effectiveness in the use of iKnowMedEHR, Lynx Mobile, and integrated technologies by the end users. Created payment accuracy algorithms using a combination of tools (Amysis, different EMR systems, Citrix, Centricity, Duo, Okta, and Health Verify. ● Responsible for managing site document the releases of information process in the prescribed electronic data system. ● Developed reports on outstanding releases and release of information histories to clients or authorized individuals. ● Ensured that records are organized in a standardized manner, including document storage. Reviews and manages purging of paper records. ● Ensured records are maintained in compliance with HIPAA Privacy rules, including those not in EHRs. This includes paper records and those stored on file servers internally and externally.

● Responsible for the delivery of accurate and timely adjudication of claims according to policies and procedures. ● Claims Auditing and Analyst projects. ● Applied extensive experience in the Health Care Industry to analyze, process, research, adjust and adjudicate claims with the use of accurate procedure/revenue and ICD-9 codes. ● Consulted with Management regarding escalated issues that impacted production and quality. ● Processed claims based upon contractual and/or Client Agreements involving the use of established payment methodologies, applicable regulatory legislation, claims processing guidelines and company policies and procedures. ● Maintained quality and productivity standards. ● Maintained compliance with (PHI) and (HIPAA) requirements. ● Obtained, assessed, analyzed, and presented a wide variety of claims data for analysis. ● Built and combined queries and extracts from data warehouses, database tables, spreadsheets to produce pertinent claims information for analysis.

● Performed reconciliation of payments and referral/precertification information in the billing system. ● Verified insurance information via hospital and insurance carrier systems. ● Confirmed that electronic and paper claims are sent to insurance carriers in a timely manner. ● Obtained, assessed and analyzed data. ● Performed front end processes and utilized several systems such as Lynx, Med Assets, & InVision. ● Delivered high-quality artifacts such as business process models, use cases, user stories, context diagrams, business rules, decision models, data dictionaries, user interface models/mock-ups, executive summaries, and others as needed. ● Managed and communicated requirements throughout the software development lifecycle.

● Provided analysis on process improvement through participation in multiple continuous improvement projects ● Claims and data analysis projects. ● Successfully completed tasks based on the business rules with configurable itineraries. ● Provided support to management for all administrative functions including creating and maintaining electronic and hard copy provider cost report files. ● Contributed to streamlining the delivery of work to users, helping to improve critical business processes and automated tasks. ● Prioritized and routed tasks based on the business rules with configurable itineraries. ● Served as a Specialist to interns and residents (IRIS) as for various projects that includes transmission of cost report information (HCRIS), wage index submissions, system for tracking audit and reimbursement (STAR) updates, and cost reports.

Handle and maintain confidential and non-routine information. Plan and coordinate all internal department meetings and external customer meetings and associated logistics as necessary. Manage colleague calendars and travel arrangements. Create and maintain the colleague information, organizational charts and department documents. Support other Assistants and receptionist during times of insufficient coverage. Participate as an integral team member and provide customer service to internal and external clients. Assisted with home care or hospice setting projects. Created multiple reports for the V.P., Medical Directors, Nurses and Clinical Managers.

Responsible for transferring medical records from a medical plan of care (PHI) to their new EMR database. Data Entry into electronic medical record database. Medical Transcription experience and full understanding of medical terminology Copy certain typed fields from a Medical Plan of Care (PHI) in paper format to the electronic record system AllScripts & McKesson. Assisted with home care or hospice setting experience. Assigned CPT codes, ICD-9-CM and ICD-10 codes for Inpatient and Outpatient physician services, in accordance with legal requirements, compliance standards, official coding rules, conventions, guidelines and definitions by applying the use of uniform coding standards to enhance data quality and the integrity of the health record.

Assigned CPT codes and ICD-9-CM codes for Inpatient and Outpatient physician services, in accordance with legal requirements, compliance standards, official coding rules, conventions, guidelines and definitions by applying the use of uniform coding standards to enhance data quality and the integrity of the health record. Assists physicians with proper documentation of services provided, coding and billing issues, charge capture process and reconciliation of charges as related to coding guidelines. Provides ongoing education to physicians and others as it relates to identified issues with coding and billing, as well as, assisting with claims corrections and denial resolution. Performed analysis of health record documentation for accounts and assigned CPT and ICD-9-CM codes as appropriate. Provided ongoing education and follow-up to physicians regarding E&M coding levels and medical necessity guidelines. Charge entry of coding data into CITRIX AND CRM systems

Customer service experience in a healthcare call center environment. Strong computer skills, experience with Microsoft office and data entry systems. Possess and demonstrate strong abilities in data entry, typing, call documentation and customer service skills including active listening. Experience in healthcare setting and knowledge of medical terminology. Utilizes IEX, CRM, and TruCare systems. · Answer inbound healthcare contact center calls and route appropriately to clinical staff. Use healthcare tools and apply problem-solving skills to identify immediate caller needs, including potential crisis calls; escalate crisis calls according to standard operating procedures. Use verbal communication strategies to effectively elicit information, gain confidence from caller and provide reassurance. Use active listening skills and interviewing techniques to accurately identify caller’s presenting concerns. Identify and employ alternative approaches to communicate with callers when encountering barriers. Enroll pregnant members into the Healthy Rewards and Smart Start program. Inform members of benefits and resources with their Medicaid plan.

Leading dental insurer providing services through efforts of over 10,000 employees.; Monitored all processing to ensure timely and accurate completion of complex claims. Analyzed priority claims and expedited processing, referring for Professional Review and follow-up on suspended claims with dental offices to obtain additional information. Consulted with staff on problematic cases. Conducted quality assurance preparation including routine production reports and sorting/ranking claims. Used varied computerized systems, including MetaVance, M.A.C.E.S.S., OPM, and LMS. Recovered $60M in overpayment of claims, based on implementation of new processing system that improved provider claims submission. Exceeded all production and quality goals, earning several performance awards. Streamlined procedures and implemented new departmental standards to improve efficiency and communication among multi-discipline teams. Recognized by management for innovative approaches and assigned special projects on the basis of expertise and positive application of experience to new challenges.