Summary
Overview
Work History
Education
Skills
Languages
Timeline
Certification
Generic
Katerina Scher

Katerina Scher

Quality Review and Audit Lead
Jefferson City,MO

Summary

Proactive and goal-oriented professional with excellent time management and problem-solving skills. Known for reliability and adaptability, with swift capacity to learn and apply new skills. Committed to leveraging these qualities to drive team success and contribute to organizational growth.

Overview

16
16
years of professional experience

Work History

Quality Review and Audit Lead

Cigna-Evernorth
08.2022 - Current
  • Conducted Quality audits to evaluate compliance with regulatory standards and internal policies.
  • Evaluated the effectiveness of implemented solutions post-audit, ensuring ongoing compliance with recommendations.
  • Collaborated with cross-functional teams to enhance operational efficiency through risk assessments.
  • Developed and implemented audit plans to identify operational risks and improve processes.
  • Mentored junior auditors, providing guidance on best practices and professional development.
  • Conducted training sessions on audit methodologies and compliance requirements for staff members.
  • Developed customized audit programs, addressing specific business needs and objectives.
  • Assisted in the successful completion of external audits through timely provision of required information and documentation.
  • Identified control gaps in processes, procedures and systems through in-depth research and assessment and suggested methods for improvement.
  • Analyzed financial data to ensure accuracy and integrity in reporting practices.

Resolution Senior Representative

Cigna – Commercial Coverage Review Department
03.2022 - 08.2022
  • Work closely with the resolution team to provide tools and techniques that support process improvement, quality and productivity
  • Provide guidance and coaching to front line employees through various tasks and responsibilities, including proper utilization of tools and applications pertaining to the role
  • Assist and facilitate training as well as provide input as a Subject Matter Expert
  • Provide meaningful data on team level support and proactively identify and act upon opportunities to improve team proficiency
  • Continuously look for opportunities to streamline processes and procedures, eliminating rework and reducing productivity variations wherever possible
  • Led comprehensive reviews of commercial coverage inquiries, ensuring compliance with regulatory standards.
  • Mentored junior representatives, fostering skill development and enhancing team performance.
  • Streamlined documentation processes, improving turnaround times for coverage decisions.
  • Collaborated cross-functionally to address complex case issues and drive resolution strategies.
  • Conducted training sessions on best practices in coverage review methodologies for new staff.
  • Developed and implemented quality assurance measures to maintain high accuracy in decision-making processes.

Coverage Review Senior Associate

Cigna – Commercial Coverage Review Department
11.2016 - 03.2022
  • Assisted Health Care Providers with pharmacy prior authorizations received via phone, fax or website
  • Provided training to representatives for the Opioid Team, Sort and Interact Process
  • Served as a Subject Matter Expert in Training classes
  • Performed research to provide accurate responses to inquiries
  • Leader of the Opioid Team
  • Created a daily report with opioid prior authorizations and distributed it via email to clinical and non-clinical staff
  • Assisted with meeting a 24 hour turnaround time
  • Ensured that any errors found were corrected immediately
  • Provided coaching and suggestions for improving efficiency and accuracy
  • Submitted feedback to improve processes or create new ones
  • Participated in the Quality Action Team to help increase the department's quality and productivity

Medical Office Receptionist

Florida Medical Clinic – Internal Medicine
10.2015 - 08.2016
  • Scheduled appointments for six providers, seven laboratories and Bone Densitometry
  • Verified insurance
  • Collected co-payments and balances due
  • Reviewed and posted pending charges for billing
  • Printed orders for specialists and procedures
  • Regularly checked schedules of all six providers and corrected scheduling code errors, appointment duration errors and other errors as necessary
  • Addressed Intergy tasks in a timely manner
  • Answered phones and assisted callers
  • Prepared medical records for patients
  • Requested medical records from other medical facilities
  • Scanned documents into the medical record
  • Faxed documents to other providers, medical facilities and patients
  • Handled all nonclinical secure messaging with patients and medical facilities
  • Completed training for HIPAA Privacy and OSHA

Server

Flocafe Lounge Bar & Restaurant
08.2011 - 11.2011
  • Assisted guests with making menu choices in an informative and helpful fashion
  • Maintained knowledge of current menu items, garnishes, ingredients and preparation methods
  • Delivered exceptional service by greeting and serving customers in a timely, friendly manner
  • Correctly calculated charges, issued bills and collected payments

Server

Happy Bar & Grill Restaurant and Sushi Bar
05.2011 - 08.2011
  • Assisted guests with making menu choices in an informative and helpful fashion
  • Maintained knowledge of current menu items, garnishes, ingredients and preparation methods
  • Delivered exceptional service by greeting and serving customers in a timely, friendly manner
  • Correctly calculated charges, issued bills and collected payments

Spanish-Bulgarian Simultaneous Interpreter

Transporte Y Distribución Arcadio Francés S.L.
08.2009 - 09.2009
  • Performed as a Spanish-Bulgarian Interpreter for a Spanish trucking company owner.
  • Translated conversations simultaneously for all of his business meetings and other appointments and interactions.
  • Performed written translation of legal documents and conversation translation during meetings with his attorney.

Education

Undergraduate - Industrial Design

Technical University of Varna
Varna, Bulgaria

Undergraduate - Spanish Philology

Sofia University “St. Kliment Ohridski”
Sofia, Bulgaria

High School Diploma -

Foreign Languages High School
Pleven, Bulgaria
05-2011

Skills

  • Critical decision-making skills
  • Coaching and mentoring
  • Project management experience
  • Team development and leadership
  • Data analytics
  • Strategic audit planning
  • Client relationship management
  • Compliance monitoring
  • Workflow optimization

Languages

English
Native or Bilingual
Spanish
Limited Working
Bulgarian
Native or Bilingual

Timeline

Quality Review and Audit Lead

Cigna-Evernorth
08.2022 - Current

Resolution Senior Representative

Cigna – Commercial Coverage Review Department
03.2022 - 08.2022

Coverage Review Senior Associate

Cigna – Commercial Coverage Review Department
11.2016 - 03.2022

Medical Office Receptionist

Florida Medical Clinic – Internal Medicine
10.2015 - 08.2016

Server

Flocafe Lounge Bar & Restaurant
08.2011 - 11.2011

Server

Happy Bar & Grill Restaurant and Sushi Bar
05.2011 - 08.2011

Spanish-Bulgarian Simultaneous Interpreter

Transporte Y Distribución Arcadio Francés S.L.
08.2009 - 09.2009

Undergraduate - Industrial Design

Technical University of Varna

Undergraduate - Spanish Philology

Sofia University “St. Kliment Ohridski”

High School Diploma -

Foreign Languages High School

Certification

DELE - Diploma of Spanish as a Foreign Language — High-intermediate level B2

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