Open To Work
TABITHA MORANO
POUGHKEEPSIE,NY
Summary
Results-driven Healthcare Operations Leader with proven expertise in optimizing claims processing and enhancing payment integrity. Led initiatives that reduced medical loss ratio and improved compliance. Experienced in managing cross-departmental teams and aligning operational strategies with organizational goals to enhance payment accuracy and ensure HIPAA compliance.
Overview
1
1
Certification
24
24
years of professional experience
Work History
Payment Integrity Consultant
HEALTHNET ONE
Poughkeepsie
08.2025 - 03.2026
- Instituted a structured Payment Integrity program that delivered Medical Loss Ratio savings through enhanced payment accuracy.
- Collaborated with external auditing firm to strengthen Payment Integrity program, facilitating successful claim payment recoupments.
- Reviewed proprietary claims payment methodology to identify discrepancies, enhancing overall payment accuracy.
- Conducted internal policy reviews, contract configurations, and provider agreement assessments to ensure compliance and operational integrity.
- Executed project planning and management tasks to ensure successful project delivery.
- Leveraged extensive knowledge of HIPAA (Health Insurance Portability and Accountability Act) to ensure that personal and sensitive information remained confidential in accordance with CMS guidelines.
Senior Manager,Claims Operations
EVICORE, DIVISION OF CIGNA
POUGHKEEPSIE, NY
03.2021 - 08.2025
- Spearheaded operational improvement initiatives by analyzing performance data and implementing scalable solutions to enhance accuracy and efficiency.
- Directed daily operations across multiple departments, ensuring seamless service delivery in a high-volume healthcare environment.
- Managed team of 5 direct reports and 51 total members through coaching and performance reviews to foster growth and accountability.
- Applied continuous improvement methodologies to optimize workflows and enhance service outcomes.
- Prepared executive-level reports and presentations that influenced strategic decision-making across departments.
- Served as liaison between business and technical teams, translating operational challenges into process enhancements.
- Contributed to client onboarding by troubleshooting complex issues and providing tailored operational insights.
- Formulated company policies and departmental workflows to ensure operational consistency and compliance.
Claim Supervisor,Claims System Configuration
EVICORE, DIVISION OF CIGNA
Poughkeepsie, NY
03.2013 - 03.2021
- Oversaw setup, maintenance, and deployment of claim adjudication engine configurations, including benefit rules and billing rules.
- Ensured accurate claim processing through thorough quality checks and audits on configuration projects.
- Finalized health plan configurations to guarantee compliant and timely provider payments.
- Mentored configuration specialists and analysts while conducting training sessions on system processes.
- Provided intra-departmental support for testing and troubleshooting configuration changes.
Supervisor, Claims Operations
EVICORE, DIVISION OF CIGNA
Poughkeepsie
10.2001 - 03.2013
- Guided and trained team of claim processors, enhancing processing accuracy through performance feedback.
- Resolved complex claims by investigating issues and implementing solutions to prevent future errors.
- Monitored compliance of claims processors with regulations and internal policies to mitigate risks.
- Coordinated communication with departments and stakeholders to address claim-related issues, improving process efficiency.
- Analyzed claim data to identify trends and areas for improvement, implementing solutions to boost accuracy.
- Facilitated implementation of new programs within claim adjudication engine to streamline operations.
Education
Medical Billing And Coding Certificate of Completion - Medical Billing And Coding
Dutchess Community College
Poughkeepsie, NY08-2000
High School Diploma -
Roy C Ketcham High School
Wappinger Falls NY06-1987
Skills
- Claims and utilization review
- Healthcare operations management
- Audit expertise
- Client and CMS audits expertise
- NCQA standards
- HIPAA compliance regulations
- Metrics analysis
- KPI analysis
- SQL reporting
- Data visualization
- Process optimization
- Project management
- Microsoft Office proficiency
- Team leadership
- Problem-solving techniques
- NCQA standards
- Client and CMS audits expertise
- Team leadership
Certification
CPT and ICD Certification
Work Preference
Job Search Status
Open to workWork Type
Full TimeLocation Preference
RemoteHybridSalary Range
$95000/yr - $140000/yrTimeline
Payment Integrity Consultant
HEALTHNET ONE
08.2025 - 03.2026
Senior Manager,Claims Operations
EVICORE, DIVISION OF CIGNA
03.2021 - 08.2025
Claim Supervisor,Claims System Configuration
EVICORE, DIVISION OF CIGNA
03.2013 - 03.2021
Supervisor, Claims Operations
EVICORE, DIVISION OF CIGNA
10.2001 - 03.2013
Medical Billing And Coding Certificate of Completion - Medical Billing And Coding
Dutchess Community College
High School Diploma -
Roy C Ketcham High School