Sandra Tacker
Independence,MO
Summary
Seasoned healthcare insurance professional with fifteen years of comprehensive experience in the industry with expertise in contract and network management, high dollar claims, claims processing, customer service and PPO/Non-PPO service issues. Proven ability to manage complex claims and facilitate resolutions for providers and members while maintaining high levels of accuracy and efficiency. Skilled in analyzing, investigating, and addressing service, payment, and member/provider issues across various departments. Adept at collaborating with internal teams and external vendors to ensure seamless operations and exceptional customer service. Proven track record in training and mentoring colleagues. Proficient in industry-specific software and tools, including Facets, Macess, MS Excel, and Access. Dedicated to contributing to a team that values quality, transparency, and excellence in the healthcare insurance industry.
Overview
15
15
years of professional experience
Work History
Contract Specialist
GEHA
Indpendence, MO
03.2009 - Current
- Manage and maintain the High Dollar report and the monthly Zelis Reconciliation report
- Analyze and investigate service issues for PPO and Non-PPO networks, including Zelis, PMCS, and UHC overpayments, balance billing, pricing issues/requests, provider appeals, and quality assurance issues
- Review, analyze, and respond to resolutions from networks and vendors for member/provider inquiries via letters, phone, or internal departments
- Research and determine appropriate actions to update, maintain, and document information in the PPO network utility and Macess system
- Analyze and research service, payment, and member/provider issues related to PPO and Non-PPO networks
- Serve as a liaison for the Transparency Pricing and Coverage process since June 2016, assisting member inquiries regarding individual providers/hospitals with contracted rates and providing fair price quotes
- Provide cross-departmental support for the Connection Dental and UHC teams when needed
- Responded to and resolved phone and internet inquiries from members and providers
- Assisted members and providers with medical, dental, prescription drug, and specialty drug claims and benefit issues
- Supported GEHA's contractual provisions in dental (CD and FedVIP) and medical claims, including Medicare, COB, and prescription drugs/specialty drugs
- Assisted HDHP members with HSA/HRA inquiries and coordinated with the HSA liaison to resolve member issues
- Supported FEHB and FedVIP, CD members with FSA inquiries
- Aided CCRs with benefit questions, lines of determination, and department policies and procedures while assigned to the Help Desk
- Cross-trained to assist the Appeals department with correspondence letters and claim adjustments
Education
High School Diploma -
Truman High School
Independence, MO05-1994
Skills
- Claims Processing
- Analytical Skills
- Keen attention to detail
- Problem-Solving
- Communication
- Excellent written and verbal communication skills
- Strong interpersonal skills
- Organizational Skills
- Efficient time management
- Proficient in managing and maintaining reports
Timeline
Contract Specialist
GEHA
03.2009 - Current
High School Diploma -
Truman High School
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