Megan Schweiger

Eagan,MN

Summary

Dynamic Healthcare Data and Eligibility Lead Analyst with 16 years of experience dedicated to enhancing accuracy, compliance, and operational excellence in complex enrollment environments. Expertise in EDI 834/5010, HIPAA compliance, and large-scale data reconciliation while managing substantial books of business, encompassing up to 150 client groups. Proven track record of exceeding SLA standards with consistent turnaround times under 24 hours, resulting in a remarkable 50% reduction in enrollment discrepancies. Recognized for successfully leading cross-functional implementations through a steadfast commitment to process improvement and innovative solutions that drive organizational success.

Overview

years of professional experience

Work History

Eligibility Account Specialist / Analyst - Sr. Associate

Cigna

Eden Prairie, MN

03.2014 - 08.2024

Oversaw management and reconciliation of comprehensive healthcare eligibility and enrollment data for 100-150 client groups.
Managed processing of daily, weekly, and monthly eligibility files to ensure timely completion within 24 hours.
Executed thorough analysis of EDI 834/5010 data to identify and rectify file discrepancies.
Orchestrated implementation calls to foster seamless collaboration among client managers, third-party administrators, and direct clients.
Led client onboarding meetings, guiding clients through implementation timelines and testing expectations.
Conducted comprehensive audits and validations of membership data to uphold accuracy and integrity.
Facilitated client liaison for eligibility and membership inquiries, ensuring prompt, accurate, and professional communication.
Spearheaded cross-functional collaboration among billing, sales, and client management teams to optimize workflow efficiency.
Led implementation of Cigna's online enrollment platform by configuring client eligibility rules, training internal teams, and resolving setup issues.

Membership Representative II

Wellpoint-Anthem

Eagan, MN

01.2011 - 03.2014

Managed enrollment and eligibility data processing for large employer groups, ensuring accuracy and compliance with client and regulatory standards.
Executed analysis and reconciliation of customized eligibility file formats to enhance EDI transmission accuracy.
Facilitated collaboration among cross-departmental teams to enhance system accuracy and minimize file errors.
Spearheaded development and implementation of process improvements to enhance operational efficiency.
Facilitated training for new team members on enrollment workflows, system updates, and compliance best practice
Managed member inquiries and resolved issues efficiently to enhance satisfaction and retention.

Patient Care Coordinator

Crutchfield Dermaology

Eagan, MN

06.2009 - 03.2011

Coordinated patient schedules, ensuring timely appointments and minimizing wait times.
Managed patient records using electronic health record (EHR) systems for accuracy and compliance.
Facilitated communication between patients and healthcare providers to enhance care continuity.
Developed and implemented patient education materials to improve understanding of treatment plans.
Trained new staff on patient care protocols, fostering a collaborative team environment.
Streamlined administrative processes, reducing appointment scheduling errors and enhancing operational efficiency.
Managed sensitive patient information with strict adherence to HIPAA guidelines, maintaining confidentiality and privacy at all times.

Education

University of Wisconsin, River Falls

River Falls, WI

Skills

Timeline