Jasmine (Ania) Martin
Pasadena,MD
Summary
Healthcare administration specialist with extensive technical background and advanced knowledge of healthcare and interventions to improve member experience; along with government agency and insurance company programs. Skilled in achieving cost containment and various corporate objectives while exceeding individual and departmental goals monthly. Knowledge of SQL, CPT, ICD-10, HCPCS and UB04.
Overview
18
18
years of professional experience
1
1
Certification
Work History
Senior Business Analyst
Sentara Healthcare
01.2023 - Current
- Led cross-functional healthcare projects from initiation to completion, ensuring alignment with organizational goals and regulatory compliance.
- Collaborated closely with key stakeholders including clinical teams, IT departments, executives, and external vendors to gather requirements, define project scope, and ensure successful delivery.
- Conducted gap analyses, workflow assessments, and root cause investigations to drive process improvements and support data-driven decision-making.
- Translated complex business needs into detailed functional specifications and worked with development teams to implement effective solutions.
- Utilized data analytics tools (e.g., SQL, Excel, Tableau) to extract insights from healthcare data, identify trends, and report on key performance indicators (KPIs).
- Managed project timelines, budgets, and deliverables, facilitating regular meetings and status updates with stakeholders to ensure transparency and accountability.
- Supported system implementations, testing (UAT), and change management activities to enhance adoption and minimize disruption
- Created detailed user stories for system enhancements, leading to improved functionality and user satisfaction.
- Used Jiva utilization management system
- Led process mapping initiatives, resulting in optimized workflows and reduced redundancies across departments.
Senior Business Analyst
Cigna Healthspring
11.2017 - 01.2022
- Participates in the analysis and development of new or revised UAT procedures and processes
- Assists in the preparation and conduct of UAT reviews and the development of test plans and test scripts
- Participates in the review of UAT procedures and processes and the development of UAT metrics for assessing the quality delivered systems
- Participates in the development of special testing requirements and procedures and in the review of new or modified business systems
- Assists in the preparation and conduct of Quality Assurance (QA) testing of new or modified applications/systems across multiple computing environments (e.g., host based, distributed systems, client server)
- Participates in the analysis and development of new or revised QA procedures and processes
- Assists in the preparation and conduct of QA reviews and the development of test plans and running SQL test scripts
- Requires a broad knowledge experience with automated testing and modeling tools, and change management and test case generation techniques
- Participates in Annual Enrollment Period testing.
- Participates in the analysis and development of new or revised UAT procedures and processes, ensuring alignment with organizational goals and regulatory compliance.
Business Analyst
Cigna Healthspring
11.2015 - 11.2017
- Actively participated in team meetings to share knowledge, exchange ideas, address challenges, and collaborate on potential solutions.
- Developed high-quality documentation to support training efforts, helping employees fully understand new systems and procedures.
- Performed gap analysis between existing systems or processes and desired state, identifying areas for improvement or enhancement.
- Improved business processes by analyzing current practices and recommending optimization strategies.
- Streamlined project management with effective communication and collaboration across cross-functional teams.
- Enabled data-driven decision making with advanced analytics tools, generating valuable insights for the organization.
- Implemented best-practice methodologies that improved overall project delivery timelines while maintaining quality standards.
- Enhanced company-wide decision-making by developing comprehensive reports on key performance indicators.
Resolution and Recovery Analyst/ Sr. Associate
Carefirst BCBS
11.2015 - 11.2016
- Review claims of varying complexity levels and identifies necessary next steps
- Analyze claim complexity trends, analyst errors and claim volume via Tableau dashboard
- Displays team leadership by working independently on assigned and additional projects as needed
- Applies complex systems to research, analyze, and price claims in accordance with processing guidelines and existing contracts
- Demonstrates the ability to pay claims across all claim types as required
- Coaches and supports peers as needed
- Other special projects and tasks as assigned
Claims Analyst
Carefirst BCBS
09.2014 - 11.2015
- Complies with applicable laws, regulations. Also ensures facility adheres to Texas Medicaid skilled nursing facility regulations
- Responsible for researching and resolving escalated and complex claim issues in a timely manner
- Authenticates information on all medical claims received
- Answers inquiries from providers regarding claims, eligibility, covered benefits, and approval status issued through call trackers
- Maintains thorough record of special projects
- Reviews medical documents
- Manages and processes nursing facility claims and documents all activities through Facet
- Collaborates with department managers to correct problems and improve services
Provider Representative II
Carefirst BCBS
04.2011 - 09.2014
- Responding to written or faxed inquiries from insured’s, providers or other parties. Includes research, letter drafting, document retention (scanning), and referrals to appropriate resource or area for expedient response
- Analyzed claims to determine extent of MMI’s liability and made approval or denial decisions and negotiated settlements with claimants in accordance with policy provisions
- Make calls to providers and insured’s to obtain information critical to the resolution of the open inquiry
- Collaborated with insurance agencies and interview claimants to correct errors, rectify omissions, and investigate questionable issues
- Applies an expert ability to analyze client contracts and needs involving current product mix, risk assessment, and revenue impact. Utilizes service techniques and technical competence for the purpose of maximizing customer or provider retention, satisfaction, and potential financial savings.
- Responds to telephone inquiries, written inquiries, and CareFirst automated inquiries from subscribers, group administrators, providers, brokers, medical professionals, and internal staff
- Resolves complex issues between providers, subscribers, and the company, involving knowledge of all products and contracts
Tier II Research Specialist
Trailblazer Health Enterprise, LLC
05.2007 - 05.2011
- Audited new customer DME orders to verify medical necessity and satisfaction of coverage criteria
- Reviewed and explained insurance plans to patients to guarantee full understanding of payment policies and procedures
- Receive, research and respond to provider related written and/or telephone inquiries, claims payment questions or guideline questions. Ensure all responses are accurate, timely; address major issues, user-friendly and comprehensive to the customer.
- Respond according to CMS directives and general Section 1011 rules and regulations.
- Made regular telephone contact with providers to discuss status of billing and reimbursement to ensure account resolution and communicated with patients to obtain payments for accounts requiring deductibles or co-pays
- Managed patient charts and company files
Education
Ph.D - Healthcare Administration
Walden University
Baltimore, MD01.2022
MS - Healthcare Administration
University of Maryland
Skills
- In-depth knowledge of HIPAA regulations, confidential records management, Current Procedural Terminology, ICD-10, HCPCS, UB04, Tableau dashboard Encoder and medical billing and coding
- Proficient in QNXT, FACETS, Claim Test Pro and EPIC/Health Connect
- Great ability to research and gather information for claim handling and investigation
- Jiva Utilization Management
- Excellent written and verbal communication skills with customers and coworkers
- Advanced proficiency in Microsoft Office (Excel, Word, Outlook, PowerPoint, and Research)
- Exceptionally skilled in quality assurance and leadership
- Tableau knowledge
- SQL knowledge
- Agile methodology
- User acceptance testing
- Stakeholder management
- Requirements gathering
Certification
- SQL Knowledge
- CAPM (PMI) July 2019
Timeline
Senior Business Analyst
Sentara Healthcare
01.2023 - Current
Senior Business Analyst
Cigna Healthspring
11.2017 - 01.2022
Business Analyst
Cigna Healthspring
11.2015 - 11.2017
Resolution and Recovery Analyst/ Sr. Associate
Carefirst BCBS
11.2015 - 11.2016
Claims Analyst
Carefirst BCBS
09.2014 - 11.2015
Provider Representative II
Carefirst BCBS
04.2011 - 09.2014
Tier II Research Specialist
Trailblazer Health Enterprise, LLC
05.2007 - 05.2011
MS - Healthcare Administration
University of Maryland
Ph.D - Healthcare Administration
Walden University
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