Summary
Overview
Work History
Education
Skills
Certification
Summary of qualifications
Timeline
Generic

Marilyn Ransby

Dayton,OH

Summary

For more than 25 years I have worked in diverse health care, and corporate settings that dealt with, but not limited to health care benefits, claims, ICD-9,ICD-10 and CPT coding, data entry, database management research, medical terminology, service level agreements (SLA), working in teams, improving data entry processes, and providing superior customer service. Through my professional and education experiences I have learned how to be an effective team member as well as a leader. I possess the skills of a self-starter, problem solver, professionalism, and trainer, with excellent computer skills including but not limited to Microsoft Word, Excel, Outlook, and other specific applications related to the company. Extensive Knowledge of Medicaid and Medicare Rules, guidelines and regulations pertaining to claims.

Overview

22
22
years of professional experience
1
1
Certification

Work History

Software Quality Analyst II

CareSource Management Group LLC
Dayton, OH
10.2020
  • Configuration Clinical Edit /Automation Team
  • Experience with Test Complete and other automated testing toolset
  • Scripting or programming experience
  • SQL Server experience, ALM (Application Lifecycle Management), UI (UiPath Orchestrator), Claims Mock Tool. RPA (Robot Programming) Citrix Applications, SNOW ticket request, knowledge of appeals and MCA, MLSS processes.
  • Work with team members, developers and department managers to develop, maintain, implement and execute a quality assurance process
  • Responsible to develop routine tests and coordinate the testing efforts for all assigned applications and code base.
  • Create and document test cases for all documented requirements
  • Manage and execute testing for all test cases: types include integration, certification, user acceptance, system, regression, and load tests
  • Develop and maintain test plans, manual and automated test scripts for user interface, functionality, system and “ad-hoc testing”
  • Ensure compliance with local, state, national and international standards and legislation

Retail Sales Associate Cashier

Burlington Department Store
Dayton, OH
02.2025 - 09.2025
  • Processed customer transactions accurately and efficiently using point-of-sale systems.
  • Assisted customers with product inquiries, ensuring a positive shopping experience.
  • Maintained organized merchandise displays to enhance store presentation and accessibility.
  • Collaborated with team members to address inventory shortages and restock shelves promptly.
  • Monitored sales floor for cleanliness and safety compliance, contributing to overall store standards.
  • Handled cash management responsibilities, including balancing registers at shift end.
  • Resolved customer complaints swiftly, fostering loyalty and repeat business through effective communication.
  • Helped customers complete purchases, locate items, and join reward programs.
  • Handled high volume transactions during peak periods without compromising service quality or accuracy.
  • Maintained a clean and organized store environment, contributing to a positive customer experience.
  • Demonstrated adaptability by working various roles as needed including cashiering, stocking shelves, or assisting in the fitting room area.
  • Streamlined checkout process for customers, reducing wait times and enhancing overall shopping experience.
  • Assisted customers by answering questions and fulfilling requests.

Software Quality Analyst – Configuration – Clinical Edit Team

CareSource
Dayton, OH
09.2019 - 10.2020
  • Experience with Test Complete or other automated testing toolset
  • Scripting or programming experience
  • SQL Server experience
  • Work with team members, developers and department manages to develop, maintain, implement and execute a quality assurance process
  • Responsible to develop routine tests and coordinate the testing efforts for all assigned applications and code base
  • Create and document test cases for all documented requirements
  • Manage and execute testing for all test cases: types include integration, certification, user acceptance, system, regression, and load tests
  • Develop and maintain test plans, manual and automated test scripts for user interface, functionality, system and “ad-hoc testing”
  • Ensure compliance with local, state, national and international standards and legislation

Sr. Operations Analyst-Claims Technical Automation

CareSource
Dayton, OH
09.2017 - 07.2019
  • Represent CTA on cross-functional project work teams, submits IT ticket pertaining to tracking and trending of claims, projects to ensure correct claim payments.
  • Assist in training staff on processing Team Foundation Server Stories, policy and procedures.
  • Experience with Microsoft Word, Excel. Knowledge in coding, billing processes, including CPT, ICD-9, ICD- 10 and HCPCS coding. Ability to generate reports, utilize the UI system to perform Mass Claims Adjustments per request.
  • Have performed testing, in Cert and INT Citrix system. Advanced knowledge of different rules and regulations pertaining to multiple Service Plans, Georgia, All Market Place Plans, Indiana, West Virginia, Kentucky, etc.
  • Always provide excellent quality service and ensure the company’s policies.

Provider Resolutions Specialist

CareSource
Dayton, OH
01.2011 - 07.2017
  • Works directly with Provider Relations Representative to resolve providers concerns (scheduling conference calls, meetings, emails, etc.).
  • Various claims adjustments. HMS, PerMedion DRG validations, HMS retractions, check refunds, posting refunds and credit balances in accounting, medical reviews, and consent forms.
  • Track and trend adjustment reasons, analyze root causes, and recommend solutions.
  • Assist with notifications of credit balance reports.
  • Openly communicate with other departments in the resolution of credit balance recoveries.

Reimbursement Claims Analyst

CareSource
Dayton, OH
08.2003 - 01.2011
  • Provides accurate and timely processing of claims.
  • Analyze and process claims for accurate payment/denial in accordance with Ohio regulations.
  • Organize and maintain departmental information regarding claims processing.
  • Identify and process Coordination of Benefits and Subrogation claims.
  • Review and expedite responses to Service Center to aid in resolving provider and member inquiries.

Education

Health & Sciences Business Management - undefined

Coding Specialist - undefined

Sinclair Community College
Dayton, OH

Fred Pryor Class for Excel users certificate - undefined

Allied Health - undefined

Sinclair Community College
Dayton, OH
01.1981

Certified Phlebotomist - undefined

Sinclair Community College
Dayton, OH
01.1981

Medical Assistant - undefined

Garfield Skill Center
Dayton, OH
01.1977

State Registered Phlebotomist & Nursing Assistant - undefined

Garfield Skill Center
Dayton, OH
01.1977

Skills

  • Test case design
  • Manual testing
  • Customer support
  • Test management tools
  • Training and mentoring
  • Functional testing
  • Test data management
  • Test environment setup

Certification

  • Certified Medical Assistant
  • State Registered Nursing Assistant
  • Certificate of Business Writing
  • Certification of Excel

Summary of qualifications

  • Medical Billing & Coding (ICD-9, ICD-10, CPT, HCPCS), Medicaid, Medicare and Commercial Insurance, Accounting, knowledge of HMS (Healthcare Management System) includes reporting, adjusting, COB, DRG Validation, Medical Bill Auditing.
  • Laboratory/Cytology Specimen Processing, Data Entry Level III, Internet, Microsoft Office: Word, Excel, PowerPoint, Various Database Systems (Cosmos, Qstar, PC-ORS, Venipuncture, Various Centrifuge Operations, Xerox, Laser Copy, Fax Machines, (maintenance & operation), Cross Functional Communication Skills, Personal accountability, Taking initiative, Individual Learning, Customer Orientation, Change Resiliency

Timeline

Retail Sales Associate Cashier

Burlington Department Store
02.2025 - 09.2025

Software Quality Analyst II

CareSource Management Group LLC
10.2020

Software Quality Analyst – Configuration – Clinical Edit Team

CareSource
09.2019 - 10.2020

Sr. Operations Analyst-Claims Technical Automation

CareSource
09.2017 - 07.2019

Provider Resolutions Specialist

CareSource
01.2011 - 07.2017

Reimbursement Claims Analyst

CareSource
08.2003 - 01.2011

Health & Sciences Business Management - undefined

Coding Specialist - undefined

Sinclair Community College

Fred Pryor Class for Excel users certificate - undefined

Allied Health - undefined

Sinclair Community College

Certified Phlebotomist - undefined

Sinclair Community College

Medical Assistant - undefined

Garfield Skill Center

State Registered Phlebotomist & Nursing Assistant - undefined

Garfield Skill Center
Marilyn Ransby