Scherrie Davis
Abingdon,MD
Summary
Accomplished Audit and Reimbursement Analyst with a proven track record at National Government Services, Inc, excelling in Medicare and Medicaid knowledge, and revenue cycle management. Demonstrated expertise in policy evaluation and Microsoft Excel, with a knack for leading complex projects and enhancing audit processes. Renowned for meticulous data analysis and strategic recommendations, significantly improving operational efficiency.
Overview
18
18
years of professional experience
Work History
Audit and Reimbursement Analyst
National Government Services, Inc
08.2022 - Current
- Provides support for Medicare Administrative Contract (MAC) with the federal government (The Centers for Medicare and Medicaid Services (CMS) division of the Department of Health and Human Services). Working to resolve complex issues involving the Medicare cost report and Medicare A and B reimbursement.
- Analyzes and interprets data and makes recommendations for change based on judgement and experience.
- Independently works on assignments and under minimal guidance from management.
- Prepare detailed work papers and present findings in accordance with Government Auditing Standards (GAS) and CMS requirements.
- Knowledge of Federal Laws, regulations, policies and audit procedures.
- Perform complex Medicare cost report desk reviews and audits which has resulted in calculating over $100,000 in overpayments.
- Analyze and interpret data per a provider's trial balance, financial statements, financial documents or other healthcare related records.
- Take leadership and sometimes participation in special projects.
Sr. Quality Assurance Analyst
CareFirst BCBS
07.2008 - 09.2019
- Ensured that complete and accurate information was entered into FACETS, including required clinical and financial documentation.
- Collaborations with Care Management when issues would arise.
- Performed monthly audits of all aspects of Operations and Technical Support, data analysis, reporting trends and recommendations which resulted in reduction of monetary errors by 15%.
- Spearheaded as well as participated in projects, workgroups, including those from upper CareFirst management and database management.
- Identified procedural, system and training issues based upon audit findings and SQL database queries.
- Reviewed, clarified and/or interpreted complex benefits and non standard benefit requests.
- Served as a subject matter expert for claims.
- Provided extensive quality assurance training via both in-person and remote teleconferences
- Monitored activities and supporting systems to meet compliance regulations
- Proposed development and testing improvements to positively impact usability, function and performance
Claims Examiner II
CareFirst
09.2006 - 06.2008
- Provided ongoing internal and external customer support.
- Analyze and research more complex claims at a high dollar level.
- Provides business support to include production monitoring and file maintenance.
- Accessed system information from CMO's such as info related to insurance authorizations, as well as collaborate with Care Management when issues would arise.
- Directed claims negotiations within allowable limit of $1,000,000 and supported successful litigations for advanced issues
Education
Some College (No Degree) - Business Management
College of Notre Dame
Baltimore, MDSkills
- Medicare knowledge
- Revenue Cycle Management
- Claims Processing
- HIPAA Compliance
- Insurance Verification
- Microsoft Excel proficiency
- Policy analysis
- Medicaid knowledge
- Policy evaluation
- Microsoft Office
- Eligibility Verification
- Data Recording
Timeline
Audit and Reimbursement Analyst
National Government Services, Inc
08.2022 - Current
Sr. Quality Assurance Analyst
CareFirst BCBS
07.2008 - 09.2019
Claims Examiner II
CareFirst
09.2006 - 06.2008
Some College (No Degree) - Business Management
College of Notre Dame
Similar Profiles
Kelly RasmussenKelly Rasmussen
Clinical Review Nurse II at National Government ServicesClinical Review Nurse II at National Government Services
Rene' McMonagleRene' McMonagle
Nurse Reviewer II – Part A Appeals at National Government ServicesNurse Reviewer II – Part A Appeals at National Government Services
Reese AllenReese Allen
Clinical Nurse Reviewer at National Government Services-ElevanceClinical Nurse Reviewer at National Government Services-Elevance