1. Employment/Experience with Cigna HealthSpring
Promoted three times within the company
July 2011 - February 2014
Cigna HealthSpring
Business Analyst Sr. Associate/Configuration Analyst II
Baltimore, MD
 Lead projects to update system configuration to adhere to new federal and state regulatory
requirements.
 Trouble-shoot configuration issues that have resulted in incorrect claims payment. Develop
remediation plan and make configuration changes within the system.
 Review healthcare provider contracts to ensure correct system adjudication with all system
changes.
 Analyze and documents business impact of configuration related issues.
 Develop and communicates effective short-term workaround procedures to address
configuration issues.
 Contribute to the communication process to impacted customers and internal management.
 Document, track, and resolve issues related to data quality
 Support business area operations/functions by setting up /modifying / maintaining simple to
complex system operating parameters by designing and configuring business rule table
entries, and/or complex macros/automated scripts. Provide day to day support of these items
to insure they work properly (including the application of appropriate QA procedures) and to
quickly fix any identified defects.
 Complete activities on time and within Standard Level Agreements and proactively identify and
communicate issues that may jeopardize delivery dates or budget to the Supervisor or
Manager.
 Determines root cause analysis of system issues.
 Coordinate with peers to analyze issue and provide end to end resolutions.
 Build provider contracts and medical benefits from bottom up in the QNXT 5.01 system.
Claims Audit Specialist February 2009- July 2011
 Perform root cause analysis on improperly adjudicated claims with a focus on institutional claims.
 Communicate changes in regulatory and internal processing guidelines to providers
 Work directly with providers and Network Management staff to reconcile and resolve provider’s
outstanding AR accounts.
 Identify problems with claims processing guidelines that cause incorrect claim payments/denials
and communicate with department leadership to have SOP’s updated to related proper
procedures.
 Analyze incorrectly paid/denied claims and determine system configuration errors that have
caused the incorrect payments to occur. Communicate the issues to the configuration support
staff to correct the errors.
 Was the lead for Joint Operations Committee (JOC) to handle five hospital clients for monthly
Excel spread sheets logs of claims issues.
 Provide written documentation to providers/clients and internal staff regarding resolution of
provider disputes.

2.  Travel to client’s facilities for face to face meetings to discuss claims issues, EOB denials and
advise of corrections needed on a claim by claim basis.
 Held monthly phone meetings with facility clients to work excel spread sheets of claims denial
issues or erroneous denials.
Claims Analyst March 2008-Febuary 2009
 Adjudicate institutional claims according to federal, state and internal guidelines.
 Use CMS and/or third party software to price claims according to DRG, RUGS, CMG or HH PPS
rates.
 Proficient using CMS, Trailblazer and HighMark search engines to identify documentation
pertinent to the correct processing of Medicare Advantage Claims.
 Proficient with both EZ-Cap and QNXT claims processing platform.