1. Cindy DeKlaven
1304 Clara Street Pittsburgh PA 15234• (412) 417-0327•cdeklaven@verizon.net
Professional Summary
32 yearswiththe GovernmentBusinessMedicare Programpossessingin-depthknowledge of the Fiscal Intermediary
StandardSystem(FISS) claimadjudication,interfaces, logicmodifications anddownstreamsystemimpacts.Able to
delivercomplex problemresolutionwithananalytical approach alongwithrootcause analysisbyunderstandingthe
multiple componentsof the systemmaintainer. Collaborate withinternalworkgroups andmeetthe expectationsof the
external customersby implementingChange Requests, (CR) Technical DirectionLetters(TDL) andFISSsystem
modificationstimelyandaccurately thatcreate desirable outcomesinyearlyGovernmentaudits. Supportthe ISO 9001
Standard of continuous improvement, prevention of product nonconformity and meeting customer expectation.
Experience
ProductionSystemSupport •GuideWell Source • 2005 – current
Performtestingof the quarterandoff quarterstandard systemreleasesandnon-base interfaces. Analyze program
changesand verifysystemoutputandexpectedresults. Prepare testmetrics,testcasesandprovide technical
guidance totestinganalystsusingsystemdevelopmentmethodologyandqualityassurance. Knowledge of the many
interfacestoFISS;PricerModules,ExpertClaimsProcessingSystem(ECPS) AutoAdjudicationSoftware ,Electronic
Data Interchange (EDI),usermaintenance files,usercontrolledparameters(PARMS),andthe interdependencieswith
the CompanionDataServices(CDS),SingleTestingContractor(STC) andCommonWorkingFile (CWF) system
maintainers. Implementdirectivesfromthe CentersforMedicare &MedicaidServices(CMS) relatedtoTDL and CR
rulings throughparticipationinexternal workgroupcalls,technical analysis,requirementanalysis,testinglogic thatis
necessarytopromote specificationstoaproductionenvironmentusingSystemDevelopmentLife CycleMethodology.
The Project/Testleadforthe InternationalClassificationof Diseases(ICD)version10 andpointof contact forNovitas
OperationsandChange Managementtoinclude butnotlimitedtoNational Coverage Determinations(NCD),
OutpatientCode Editor(OCE) andICD-10 crosswalks. Actedasliaisontoobtain licensesforthe ICD-10 Code
TranslationTool (CTT),a 3M software application.Otherprojectsinclude Legacy,JLandJH Medicare Administrative
Contractor (MAC) transitions,leadanalystforVeteransAdministration(VA) andIndianHealthServices(IHS) specialty
contract work,sequestrationchangesandconductedthe annual EmployeeFISScertificationtodemonstrate the access
controlswere inplace bya leastprivilege model.
The BusinessContinuityCoordinatorforProductionSystemSupport(PSS) Pittsburgh office toincludeDisaster
Recoverydrills andTable TopExercisesthatismaintainedinourBusinessContinuitySustainabilityPlannertoensure
Novitascontinues critical businessfunctions andprocessesafterabusinessdisruptionordisaster.
Currentlyina PilotTesting/Ambassadorrole of validatingnew applicationsoftware releasestoreduce andeliminate
impactwhenproductionchangesare implemented. Applicationsinclude butnotlimitedtoJAVA,MicrosoftProducts,
InternetExplorer,Adobe Products,Windows10and Citrix Receiverfordesktopsandteleworkerlaptops.
ProviderCustomerService •HighmarkMedicare Services• 2004 – 2005
Single pointof contactfor providersandvendorsusingMedicare (EDI) whoare experiencingclaimtransmissionissues
by verifyingacknowledgmentandrejectfiles. Inaddition,assistedproviderswithDirectDataEntry (DDE) FISSlogonid
and passwordsetup, assistedin navigatingthrough signonscreensandmaintainedsecured logonaccesswhile
adheringto Medicare securityrequirementsfoundinthe National Instituteof StandardsandTechnology(NIST).

2. ClaimsAdjudication/RecoverySpecialist• Highmark Medicare Services• 1984 - 2004
Jobresponsibilitiesinclude butnotlimitedtoSeniorClaimsadjudicator,SubrogationAnalystandMedicare Secondary
Payer(MSP) Recovery fromthirdparty liabilitysettlementsbyworkingwithattorneys,beneficiaries, insurance
companiesandprovidersinaprofessionalmanner. Adjudicatedcomplex andunusual variationsof advancedclaims
includingrefunds,adjustmentsandotherpartyliability. Servedasgroupleadbycommunicatingtechnical and
procedural questions, providedtrainingandidentifiederrortrendswithrecommendationstoimprove quality. Joined
the ContinuousBusinessImprovementteamandachievedaTeamExcellence award.
Other Technical and Professional Skills:
Oracle ECPS AutoAdjudication Software- Cobol Language
SharePoint Outlook
Technical/Procedural Writing MicrosoftWord/Excel