Sandra A. Guidry Tucci has over 25 years of experience in the workers' compensation industry, including regulatory auditing, managing data reporting and integrity, and implementing electronic billing standards. She has worked remotely for the past 10 years as a senior business analyst for OptumInsight and Ingenix, where her responsibilities included ensuring data integrity, maintaining payers lists, and resolving errors. Prior to that, she spent 15 years at the Texas Department of Insurance as a regulatory auditor and business analyst, where she led the implementation of electronic medical billing for the state using the IAIABC 837 format.

1. Sandra A. Guidry Tucci (512)337-7531
2120 Golden Arrow Ave. sguidry59@yahoo.com
Cedar Park, Texas 78613
Worked in the Workers’ Compensation Industry for over 25 years performing regulatory and
compliance audits, managing data reporting and data integrity, project lead for implementing ANSI
X12 837 eBill, testing bill review software, and implementing payers. Excel in being detailed,
resolving issues, creating improved processes and working with state regulators. Self-directed
professional who has worked remotely for 10 years.
• Compliance and Regulatory Analysis
• Business Process Improvement
• Functional spec writing and testing
• Business Requirements & Specifications
• ANSI X12 Formats
• Workers’ Comp Medical Bill Reporting
PROFESSIONAL EXPERIENCE
OPTUMINSIGHT (United Healthcare) CLEARINGHOUSE, Denver, CO (WFH) 2010 –2016
Sr. Business Analyst
• Implement an electronic connection for new customers/payers wanting to partner with OptumInsight
Clearinghouse. Providers send bills electronically (ANSI 837) to payers via OptumInsight Clearinghouse and
payers return electronic acknowledgments and remittances (ANSI 277s and 835s).
• Ensure data integrity across all electronic files
• Ensure state specific edits are in place
• Maintain and update payers list on a weekly basis
• Initiate a project to automate the payers list to make it more efficient
• Research and resolve error messages, defects and technical issues on electronic file submissions
• Queue monitor responsible for assigning tickets to business analysts to work tickets
• Coordinate with partners and internal staff to change over to a new internal ECG server
• Coordinate with partners when changing their server and credential information
• Coordinate with management to bring new customers/partners on board
INGENIX (United Healthcare), Salt Lake City, UT (WFH) 2006 – 2010
Sr. Business Analyst
• Provide business requirements for functional specifications for programming
• Develop and perform UAT per requirements and assist in data mapping
• Monitor state reporting regulations for 25 jurisdictions
• Communicate effectively with jurisdictions to recommend changes to their requirements
when necessary
• Project Lead to assist the state of Oregon’s workers’ compensation in implementing its
version of the International Association of Industrial Accident Boards and Commissions (IAIABC) electronic
medical bill 837
• Provide research for assessing and resolving client issues related to data reporting
• Determine and present options for problem resolution
• Provide timely and detailed response to payers/clients on operation support issues

2. • Subject Matter Expert (SME) for industry changes and state-specific
requirements/mandates related to workers’ compensation, auto and medical liability
- Track new states mandates
- Collaborate with IT support to ensure edits are installed
• Provide updates to the payer/clients regarding new state mandates
Sandra A. Guidry Tucci Page 2
TEXAS DEPARTMENT OF INSURANCE (Division of Workers Compensation (DWC)) 1991 - 2006
Austin, TX
Regulatory Auditor/Business Analyst II
• Project Lead for developing, planning and implementing the electronic medical bill data reporting to the state
using the International Association of Industrial Accident Boards and Commissions (IAIABC) EDI 837 format.
TX was the first state to implement the IAIABC’s medical bill 837.
• Coordinate medical requirements between DWC and the IAIABC
• Develop requirements and guideline specifications to enhance the quality of the state’s database
• Provide analytical and design support for business process improvement projects, including all aspects of the
systems development life cycle
• Audit electronic test data for accuracy and approval for transmission of medical bills (Professional, Hospital,
Pharmacy and Dental)
• Develop system strategy for tightening programming edits to improve the quality of the medical bill database
• Serve as the coordinator between trading partners and the IT division to ensure compliance with data
specifications
• Identify data specific scenarios to perform quality assurance using SAS and XML programs
• Develop monitoring report to analyze and audit electronic medical bill data for data integrity
• Develop surveys and research information to identify trading partner’s business requirements for electronic
media
• Perform on-site audits of payers and health care providers for regulatory compliance
• Handled large data sets and analyzed for compliance with state fee schedule
• Regulate compliance of insurance carriers on data integrity
• Member of the Medical and ProPay Committees of the IAIABC
• Assist the medical committee, beginning in 1994, in developing the national standard for reporting workers’
compensation electronic medical bill data using the 837 format
EDUCATION/TRAINING
• Lamar University, Beaumont, TX
• Project Management
• Hands-on 837 Medical EDI 837 training
• ANSI EDI X12 Medical 999, 277, and 837 format structure training
COMPUTER SKILLS
• XML software
• Outlook
• SQL
• Word, Excel & Visio/PowerPoint

3. • Dashboard • Legacy and COMPASS mainframe