This resume is for Gena Renee Fortune, who has over 13 years of experience in health insurance and project management. She has a background in claims processing, requirements analysis, testing, and training. Her most recent roles include home health aide and medical insurance verification specialist. She is skilled in various systems, coding, and administrative tasks.

1. Gena Renee’Fortune
317-897-6501 (h) 317-605-8220(m) MsFortune54@Gmail.com
PROFESSIONAL SUMMARY
 I have over 13 years experience in the Health Insurance industry.
 Experience working with Project Management developingBusiness Requirements.
 Experience obtaining business needs through analysis, and interpretation ofdata. Experience documentingfunctional specifications.
 Development experienceproviding input ofalternatives and best forbusiness recommendations.
 Develop and execute case testing scenarios.
 Strong analytical and leadership skills.
 Ability totrain on new procedures, as well as effective presentation skills
 Excellent interpersonal skills. Ability towork independently with minimalsupervision and within a team/group environment.
 Liaison between technical and non technical business associates.
 Ability tomeet required deadlines.
 Skilled in all lines ofbusiness – Professional and Facility claims, CustomerServices, Adjustments/Refunds as well as knowledgeofthe
business in orderto write Specifications and Business Requirements.
 Lead BA for the Facets DB project.
PROFESSIONAL EXPERIENCE
Home Health Aide and Personal Care Aide 02/13-Present
 Common duties performed assist client with bathing and dressing, wound care, monitorvitals as well as
sugar. Handle daily housekeeping includinglaundry and meal planningand preparation. Assist with any
other job duties required by the patient.
Rehab Medical Insurance Verification Specialist 09/12- 02/13
Durable Medical Equipment (DME) Supplier
 Responsibilities include but not limited to: Contacting new and existingpatient’s insurance carriers to
determine benefits and eligibility. Determineifthe patient is active and eligible forDME services. Calculate
the amount insurance will coverand the patients responsibility. Contact patients toobtain insurance
information when not provided orthe carrierhas indicated they are terminated from the policy submitted.
Train and supervise new hires as well as audit their work at 100% until my Managerfeels they can work
independently based on my feedback. Work with the billingas well as CustomerService departments as
well.
Stewart &Stewart Attorney’s (MRM) Medical Records Mgmt 06/10- 05/12
Personal Injury Attorney’s
 Responsibilities include but not limited to: sending the initial request for hospital and physician medical records. Once received, the
records/ bills are scanned and logged into the needles system. Assist the paralegals with many requests. I am in constant contact with
facilities as well as providers office. Handle the HIPAA authorizations as well as many other administrative duties.
 Obtain Medical Records via Healthport website. Saved the PDF file to the clients records file.
Jacobson Solutions (Consultant)
Anthem Blue Cross of California- CCOACost Containment & 04/08-11/09
Overpayment Avoidance/Cash Control
 Responsibilities include but not limited to: Handling Provider and Subscriber voluntary and involuntary refunds. Adjusted
professional/professional Medicare, Medicaid and facility claims to reflect the correct payment. Adjustments included full and partial
credit adjustments.
 Handled manual check requests due tolack ofactivity with provider bank account, sub payable, returned due to bad address. Scanned all
supporting documentation, submitted a manual check request tothe Cash Operations manager. Once the manager approved request was
sent to the accounts payable department. Obtained and provided any additional information required by accounts payable department.
Once approved by accounts payable mailed live checks out to provider or sub.
DSS (Eli Lilly and Company) Indianapolis, IN (Contract work) 06/07 – 08/07
Medical Assistant
 Responsible formass mailings, data entry, reviewing monitoring reports, communication toinvestigatorsites, maintaining Collaboration
Databases. Primary rCDA support clinical trial studies.
Republic Airways Shuttle America Indianapolis, IN 10/06 – 02/07
Flight Attendant
 Responsible forthe safety and comfort of customers. Duties involved making customers feel valued and

2. Gena Renee’ Fortune
welcome, providing food and beverage service, assisting customers with baggage, helping those customers
who are ill or have disabilities, and operating mechanical and safety equipment. Assisted in performing all
safety, service and cabin preparation duties
Anthem Blue Cross Blue Shield, Indianapolis, IN 08/94-06/05
Operations Business Analyst, Operations Trainer, Service Administrator
 Analyzed and documented business requirements. Worked closely with Project Management. Documented the entire professional and
some facility business requirements.
 Assisted in functional modeling and design. Produced project deliverables.
 Lead BA over all of the professional specifications. Lead BA for all professional test case scenarios.
 Developed and executed systemtesting. Developed case test situations fordifferent types of claims that pass through the system.
Tested and signed offon testing prior to implementation.
 Trained and assisted end users with the implementation ofnew technology.
 Documented functional specifications. Worked with the programmers toinsure accurate results.
 DB2, Fileaid, CICS and Mercatorexperience.
 Worked with SQL, Visual Basic and Cobalt programmers.
 Lead BA for Midwest providerinquiry and pricing database.
 Lead BA for Professional and Facility OCR project.
 Documented and tested Streamline project.
 EDI and 837 knowledge.
 Documented enhancements forexisting systems.
 Responsible fortesting priorto implementation
 Provided alternatives and recommendations todirectorand management team. Provided input and counsel toinsure best for business
decisions were made.
 Responsible fortraining all new Anthem BC/BS associates on FEP Professional claims. Then selecting and cross training chosen
associates on facility claims.
 Responsible forobtaining and documenting state specific policy and procedures, Medical policy and FEP specific guidelines for IN,
KY, OH, CO, NV, CT, NH, ME and VA. I was the trainer for all 8 states in which all utilized different providerinquiry and pricing
systems. Was responsible forcross training existing associates on system changes and state specific processingchanges. Traveled to
each state and obtained specific differences as well as learned systems. Documented and cross trained associates tohandle each state.
 Attended the Systems Conference offsite meeting each year. Documented yearend system changes and trained all associates on
upcoming changes forthe New Year.
 Developed on line processing manuals via Robohelp and maintained. Loadedall Medical Policy and FEP specific rules intothe
Streamline processing system.
 Responsible forinsuring standards ofaccuracy and timeliness for claims, refunds, and adjustments.
 Assisted with training and updates; answerclaim questions and mentor.
 Supported the clerical staff.
 Handled mailroom and image entry issues.
 Assisted in the image entry contingency plan.
 Assist with marketing field activities during Open Season enrollment.
 Instrumental in strategic planning.
 Assisted with the OPM, LOCCA and CPR audits.
 Performed claims demonstration for Colorado/Nevada.
 Assisted with desktop standardization Y2Kupdate.
 Assisted in the move process to the Lytle Center.
 Handled five special accounts forirate members.
 Was a memberofthe Anthem Safety Team.
 Was the contact for the help desk and Tag security
 Assisted with interviews.
EDUCATION
1996 – 1998 Ivy Tech State College, Indianapolis, IN
3.9GPA– Nodegree obtained.
1993 – 1994 Midwest CareerCollege, Indianapolis, IN
4.0 GPA–MedicalAssistant

3. Gena Renee’ Fortune
ADMINISTRATIVE SKILLS
 Appointment scheduling
 Customerservice
 Microsoft Word, Excel, Access, Project and Visio
 ICD-9 and ICPT/HCPCS Coding, Insurance Billing, Transcribing
 Claims processing, adjustments, refunds and voids.
 10-key by touch
 Imaging
 Claim PRO
 Lotus Notes
 Medical terminology
 CICS
 WGS (WellPoint Group System)
 TPX
 Streamline
 Diamond
 Facets
 ACES
 AIMS
 Amisys
 Genesys
 Business Objects
 Needles
 Lazarus
 Endeavor
 Connex
 Brightree
 Hollander
CLINICAL SKILLS
 Patient Preparation
 Vital signs
 EKG’s
 UA, Labs, venipuncture
 Injections
 CPR/First Aid