Chantay White
Windsor Mill
Summary
With 10+ years of experience in QNXT Medicare claims processing and configuration, I am skilled in pursuing a rewarding career as a Claims Lead Analyst or Benefits/Contract Configuration Analyst. As a Subject Matter Expert (SME), my expertise in Medicare claims and effective collaboration make me a valuable asset in any professional setting. I possess extensive knowledge and hands-on experience in the field, enabling me to contribute significantly to the success of any team.
Overview
13
13
years of professional experience
Work History
Provider Network Consultant
HCSC Merge From Cigna
03.2025 - Current
- Offered configuration guidance to enhance deployment workflows.
- Mentored junior team members to improve their technical skills and understanding of networking concepts through hands-on training sessions.
- Analyzed and recommended solutions and upgrades to services to streamline processes.
- Delivered tailored presentations to non-technical stakeholders, effectively communicating complex concepts in a clear manner.
- Increased client satisfaction by providing timely technical support and addressing their specific needs.
- Streamlined network management processes by developing and documenting standard operating procedures.
- Provided configuration recommendations and assistance in customer deployment.
- Conducted thorough network audits to identify vulnerabilities and recommend appropriate remediation actions.
- Led efforts to troubleshoot complex network issues, working closely with colleagues across multiple departments as needed for resolution.
- Consistently met project deadlines while maintaining high-quality work standards through effective time management techniques.
- Managed complex projects from initiation to completion, ensuring timely delivery within budget constraints.
Medicare Accounts Receivable Specialist
Cigna
05.2023 - 03.2025
- Addressed complex issues as subject matter expert.
- Demonstrated expertise in both UB04 and 1500 form showings within Medicare Advantage claims.
- Utilized CMS pricers for accurate financial assessments.
- Managed benefit plans and contract settings using QNXT.
- Collaborates with account management team to oversee AR processes.
- Collaborates with experience manager and matrix partners to identify, resolve and improve open issues
- Solves discrepancies in accounts receivable using in-depth analysis.
- Formulates action plans to address segment-level trends.
- Partners with account management to devise actionable improvements for boosting service levels driven by root cause findings.
- Consistently meets and surpasses Service Level Agreements.
- Facilitated ongoing provider understanding of updated Medicare rules and internal procedures effectively.
- Engages in in-person discussions with EM to provide AR expertise.
Claims Supervisor
Cigna
05.2022 - 05.2023
- Demonstrated expertise in handling Medicare Advantage claims with proficiency in UB04 and 1500 forms.
- Utilized provider fee schedules and CMS pricers for accurate pricing.
- Executed configurations of contracts and benefits in QNXT.
- Created and implemented action plans for enhancement.
- Educates team on emerging issues and trends, reducing error rates.
- Conveyed operational procedures and returned service questions during client meetings.
- Tracks performance metrics to prevent monetary repercussions.
- Oversaw team performance metrics and implemented continuous improvement actions.
- Fostered positive interactions with professionals across different sectors.
- Conducted weekly meetings with team members and offered constructive feedback.
- Completed weekly payroll using Operations Management Systems.
- Maintained accurate workforce data through timely updates in Work Day.
- Ensures precise and prompt adjudication of claims.
- Deliver direction and guidance for policies, procedures, and workflows.
- Supervised adherence to claim service standards.
Claims Lead Analyst
Cigna
10.2018 - 04.2022
- Possess expertise in handling Medicare Advantage claims.
- Coordinated pricing with provider fee schedules and CMS pricers.
- Optimized configuration processes within QNXT.
- Exhibited proficiency in handling all types of claims as per business requirements.
- Researched and resolved complex claim issues efficiently.
- Recognizes error patterns and informs relevant departments for adjustments.
- Suggests enhancements for process efficiency.
- Applied peer support techniques to drive change initiatives.
- Managed and led teams on significant tasks.
- Independently completes assignments and project tasks.
- Displayed behaviors aligned with customer-centric principles, enhancing satisfaction levels.
- Provides mentorship while leading implementation of claim initiatives.
- Communicates with internal partners and external customers exhibiting high professionalism.
- Engages consistently in remote team discussions.
- Efficiently spots any virtual obstruction for the supervisor.
- Leveraged digital tools including Lync, Outlook and WebEx.
- Took charge of extra responsibilities such as leading meetings and assisting with special assignments.
- Collaboratively works with supervisor to develop, prepare oneself to be ready for next business opportunity
- Supported configuration processes alongside relevant departments.
- Participates in operational meetings and training sessions as necessary
- Adhered to HIPAA and company guidelines to safeguard privacy and confidentiality.
- Completed various special projects and tasks as assigned.
Claims Senior Representative
Cigna
08.2014 - 10.2018
- Evaluate claims with DRG and APC coding for appropriate actions including payment or denial.
- The daily use of Encoder Pro, CMS site, Fee Schedules, NPPES Novitas, CCMS for authorization and referrals pricing claims by CMS guidelines
- Processed appeals by ensuring inclusion of medical records, invoices, and documentation.
- Utilized Change Healthcare and Etracks for managing paper and electronic claim images.
- Managed claim operations through QNXT software.
- Maintained consistent use of Microsoft Office tools.
- Administered refunds through mailing system and AppX application.
- Addressed member and practitioner grievances and appeals with minimal supervision.
- Addressed and settled member grievances promptly.
- Assigned daily Call Trackers for professional claims and facility claims at rates of 8 and 6 per hour, respectively.
Patient Registrar (Part Time)
MedStar Harbor Hospital
08.2014 - 10.2015
- Ensured accurate collection of patient information.
- Executed effective insurance verification procedures.
- Directed bed assignments for incoming patients.
- Perform actions to facilitate admissions.
- Oversaw patient transfers and discharges.
- Managed operations across different platforms including Medstar system, Talent Manager and Almega.
Customer Advocate
Mobile X Trident
09.2013 - 08.2014
- Managed communication with patients and insurance companies via phone.
- Managed patient demographic records efficiently.
- Handled electronic and mailed claim billing efficiently.
- Handled tasks using both IDX and Centricity platforms.
- Managed indigent patient cases with precision.
- Generated accurate documentation for patients.
- Transmit claims and information to necessary facilities.
- Handled payment collections and receipt distributions efficiently.
- Made necessary revisions to patient records with supervisory consent.
- Managed 43 statements and call logs daily.
- Contacted insurance companies to verify coverage.
- Directed incoming calls across the facility.
Billing Specialist
Health Kare Ally
09.2012 - 02.2013
- Handled patient payment postings.
- Verified the accuracy, completeness, and regulatory compliance of patient data.
- Oversaw timely submission of secondary claims.
- Tracked claims to confirm resolution and payment adherence to 30-day timelines.
- Ensured proper payment of claims by auditing EOBs.
Education
BACHELOR OF BUSINESS ADMINISTRATION - Health Services Administration
STRAYER UNIVERSITY
North Carolina09.2023
MEDICAL BILLING AND CODING DEGREE - Medical and Body Systems Terminology
FORTIS INSTITUTE
Baltimore, MD09.2012
Skills
- Learning Agility
- Critical Thinking
- Flexibility and Adaptability
- Communicating
- Excellent Interpersonal Skills
- Excellent Phone Skills
- Customer Service Experience
- Facility Administration
- Operations Management
- Types 50 WPM
- Clerical
- Time Management
- Microsoft Office
- Word and Excel skills
- Claims Adjustment
- Financial Software
- Documentation Skills
- Data Entry Skills
- Analyzing information
- Problem solving
- Verbal communication
- General math skills
- Statistical analysis
- Experience with Professional Claims and Facility Claims
- QNXT Claims System
- Understanding Medical Terminology
- Root Cause Analysis
- Insurance Verification
- HIPAA
- Content Management Systems
- DRG
- ICD-10
- SharePoint
- Workday
- Windows Remote Desktop
- Accounts Receivable
- Documentation Review
- Wiki Systems
- Operating Systems
- Configuration management
- Customer service
- Typing
- Medical terminology
- Clerical experience
- Hospital experience
- Cash register
- Remote access software
- EDI
- Research
- PeopleSoft
- Adobe Acrobat
- Fee Schedule Pricing
- Leadership
- Microsoft Access
- Windows
- Presentation skills
- Systems analysis
- Inpatient
- Analytics
- Agile
- SQL
- Process Improvement
Contact
Anywhere, US for any employer
Timeline
Provider Network Consultant
HCSC Merge From Cigna
03.2025 - Current
Medicare Accounts Receivable Specialist
Cigna
05.2023 - 03.2025
Claims Supervisor
Cigna
05.2022 - 05.2023
Claims Lead Analyst
Cigna
10.2018 - 04.2022
Claims Senior Representative
Cigna
08.2014 - 10.2018
Patient Registrar (Part Time)
MedStar Harbor Hospital
08.2014 - 10.2015
Customer Advocate
Mobile X Trident
09.2013 - 08.2014
Billing Specialist
Health Kare Ally
09.2012 - 02.2013
BACHELOR OF BUSINESS ADMINISTRATION - Health Services Administration
STRAYER UNIVERSITY
MEDICAL BILLING AND CODING DEGREE - Medical and Body Systems Terminology
FORTIS INSTITUTE
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