Shannon Klar
Gray,ME
Overview
15
15
years of professional experience
1
1
Certification
Work History
Client Policy Specialist
Zelis
05.2022 - 12.2025
- I work in a client facing role as the SME on all Zelis editing product.
- With the Account Manager, I lead the discussions on new and existing client opportunities on regularly scheduled client meetings.
- This requires an expert level of understanding of correct coding, auditing, claim adjudication, client policies and Zelis edits.
- I proactively monitor my assigned clients monthly edit summaries and escalate any issues to the appropriate area.
- I effectively interpret my clients intent for edit customizations and support post production validation.
Clinical Code Edit Lead
Cigna
08.2020 - 04.2022
- Review quarterly edits being submitted by our vendor, Change Healthcare. The edits must be reviewed to Cigna Policy and The Centers for Medicare/Medicaid coding rules.
- Review proposed edits for future viability and savings.
- Collaborate with many other departments for claim engine errors, questions from Providers and review of competitor edit.
- Met deadlines while maintaining high-quality deliverable.
- Committed to delivering excellent customer service while working in a fast-paced environment. Demonstrated ability to manage multiple tasks while remaining adaptable and flexible.
Quality Advocate, Clinical Investigator And Recovery Resolution Analyst
Optum div United Healthcare
02.2012 - 07.2019
- Conduct reviews of claims identified from algorithms to verify correct coding of CPT, HCPCs and ICD codes.
- Review medical records to extract data for HEDIS and STARS quality measures. Schedule follow up meeting with Providers to collaborate on best practices for total patient care.
- SME to the Appeals department for resolution of Provider disputes and appeals submitted.
LPN
Springbrook/Genesis
10.2010 - 02.2012
- Recorded essential information about patient issues and communicated to doctor during appointments.
- Monitored patient health conditions and scheduled appointments to provide further care.
- Educated patients and families on treatment plans and medications.
- Assisted with collection, labeling, and timely processing of specimens.
- Helped with admission, transfer, and discharge of patients.
- Developed and maintained effective relationships through effective and timely communication.
- Collaborated with physicians and other healthcare professionals to deliver quality care.
- Maintained patient charts and medical records in EMR software.
- Took and recorded vital signs in patients to determine fitness and identify immediate health issues.
Education
Associate of Science - Nursing
Intercoast Career Institute
South Portland, MaineHigh School Diploma - General Studies
Geneva Community High School
GenevaCertification
- LPN12955
- BLS
- CPC (Certified Professional Coder)
- CPMA (Certified Professional Medical Auditor)
Timeline
Client Policy Specialist
Zelis
05.2022 - 12.2025
Clinical Code Edit Lead
Cigna
08.2020 - 04.2022
Quality Advocate, Clinical Investigator And Recovery Resolution Analyst
Optum div United Healthcare
02.2012 - 07.2019
LPN
Springbrook/Genesis
10.2010 - 02.2012
Associate of Science - Nursing
Intercoast Career Institute
High School Diploma - General Studies
Geneva Community High School