Experience

Evernorth Health Services

• United States
• Hospitals and Health Care
• 700 & Above Employee

• Data Management Strategy & Governance Lead Analyst

  • Sep 2012 - Present

  * Provided healthcare code set knowledge and expertise to support maintain and assist in managing use and distribution of healthcare industry standard code set data. * Focused on educating or sharing healthcare code set data knowledge to assist in improving and optimizing business processes, facilitate healthcare clinical and operational decision making as well as support interoperable electronic reimbursement activities. * Ensured that industry standard and proprietary code sets and crosswalks remained up to date in a central database by loading content received from vendors or modeling data received from claims systems and team members. *Worked closely with IT area to ensure smooth bi-weekly data promotions and downstream of code sets and crosswalks to customers. *Validated data downstreamed to customers and worked with IT to troubleshoot and correct any issues Show less



Cigna Healthcare

• Hospitals and Health Care
• 700 & Above Employee

• • Dec 2010 - Sep 2012

  * Provided thorough quality review of all network responses and Geo Access reports for RFPs and RFIs along with coaching and constructive feedback to Network and Geo team members. * Regularly met with team managers and trainers to identify knowledge gaps or needed training and offered solutions to close those gaps.* Worked to integrate the teams into a more streamlined quality review process as well as tracking average scores and error trends.* Maintained communication with the network and Geo analysts to discuss edits and strategies. Show less

• • Dec 2008 - Dec 2010

  * Provided thorough review of all ad-hoc requests, RFPs and RFIs along with coaching and constructive feedback to Network team members, offering solutions to knowledge gaps or needed training.* Developed and conducted a formal training curriculum for Network RFP and RFI new hires.* Identified and lead project work associated with Network data, process, training and quality review. * Coordinated the completion of overflow RFPs and RFIs, maintaining or exceeding all performance objectives of a Senior Network RFP Analyst.* Participated in department and division level project work, driving positive change throughout the organization. Show less

• • May 2004 - Dec 2008

  * Supported the Sales organization by producing marketable requests for proposal and requests for information for both Middle Market and National Accounts clients.* Analyzed and produced data elements for health insurance products using existing databases and by working with Matrix partners.* Provided guidance to Sales on a consultative basis throughout the RFP process in order to produce high quality and consistent proposal responses.* Acted as a Subject Matter Expert for internal department members as well as external customers with regard to network and health plan data.* Mentored and assisted newer team members. Show less



UnitedHealth Group

• Hospitals and Health Care
• 700 & Above Employee

• Senior Network Account Representative

  • Feb 2003 - May 2004

  * Worked in conjunction with Network Account Managers in order to maintain the integrity of physician and facility networks. * Acted as a point person for the Network Account Managers and triaged projects and daily functions to Network Account Representatives. * Assisted providers in all aspects of problem resolution including credentialing concerns, demographic changes and resolving escalated claims issues to ensure payment according to member benefits and contracts. * Served as support staff to Middle Market Sales Team in order to add new membership and recognize network growth opportunities. Show less