Tamara Simmons
Summary
Innovative professional with a Bachelor of Science in Healthcare Administration and Management. Over 28 years in the healthcare industry, including 19 years in project management, leading more than 250 projects. Expertise in enhancing operational workflows and compliance ensures a strong impact on patient care and service excellence.
Overview
31
31
years of professional experience
Work History
Unit Manager Medicare PCP/Transplant/Hospice
Health Care Service Corporation (formerly Cigna Healthcare)
03.2025 - Current
- Develop and manage Medicare Enrollment PCP operations.
- Spearhead enhancements in Claims system to reduce grievance/complaints by 18% relating to PCP related Claims fallout
- Implemented strategic initiatives to streamline processes and ensure compliance with regulatory standards, enhancing overall operational efficiency.
- Oversee training, process mapping & quality coaching for Transplant/Hospice work, including TRR & claims system updates .
Senior Supervisor, Medicare Enrollment & Eligibility
Cigna Healthcare
07.2024 - 03.2025
- Supervised Quality Auditing & Technical Coaching team for Enrollment/Eligibility Department, trained staff on new Enrollment/Claims system, Trizetto EAM/FACETs.
- Managed CTM/grievance team to address enrollment-related Medicare complaints, implementing process updates based on analysis of findings.
- Conducted root cause analysis and process mapping, leading to implementation of targeted improvements.
Operations Lead Analyst Medicare Enrollment & Eligibility
Cigna Healthcare
06.2021 - 07.2024
- Spearheaded 23 process refinement projects, saving 14,000-man hours in 2 years by enhancing operational workflows and reducing processing times.
- Managed Incoming/Undeliverable Mail process, ensuring compliance with CMS regulations while enabling a team of 20 to operate independently and maintain high-quality standards.
- Developed COB/CNSP/OOA processes through process mapping, creating SOPs and work instructions for new enrollment and claims processing systems to enhance operational workflow.
Medicare Claims Lead Representative
Cigna Group
03.2020 - 08.2021
- Identified, orchestrated, and implemented process to recover four types of claim leakage totaling over $2.5 million.
- Championed recovery work, streamlined check processing, and improved refund tracking, achieving approximately $8K in monthly recuperation.
- Established and supervised quality monitoring practices for claims, eligibility, netOps, and call center interactions, enhancing communication for reporting incidents across departments.
Owner/Consultant
ChiroSupport
02.1995 - 12.2015
- Consulted with medical doctors, chiropractors & practice managers on practice building procedures, enhancing patient care and driving practice growth by 37% annually.
- Trained and advised staff on HIPAA, patient care, insurance and billing practices, contributing to a patient retention rate of 86%.
- Developed and maintained HIPAA compliance standards, ensuring regulatory adherence and supporting operational efficiency.
Education
Bachelor of Science - Healthcare Administration and Management
Colorado State University Global Campus
01-2022
Skills
- Patient management systems
- Quality compliance
- Regulatory compliance
- Process improvement
- Operations management
- Efficiency strategies
- Project management tools
- Microsoft Excel
- Teams and Webex
- Team leadership and collaboration
Volunteer
- Lake View Foundation, Treasurer of the Board of Directors, 2024-09, Present, Oversee the organization's financial health, reporting on economic status to the board of directors, ensuring transparency and accountability., Prepare and present financial reports, including income statements, balance sheets, and cash flow statements, enhancing financial decision-making., Maintain accurate financial records and documentation of all transactions, facilitating efficient banking transactions and donation receipts.
- Boone Scenic Valley Railroad, Car Host, Boone, Iowa, 2024-06, Present, Host for Thomas the Tank Engine tour and Santa Express train, including storytelling, song leading and other assistance as needed
- Lion's Club 9NW, 2nd Vice President, Wall Lake, Iowa, 2024-04, 2026-05, Assist with the recruitment, vetting, and selection process for three annual high school scholarships, ensuring a fair and transparent selection process., Coordinated and managed fundraising events, securing headline entertainment and overseeing event logistics, resulting in successful and well-attended events., Supported event setup, teardown, and serving, contributing to the overall success and smooth execution of fundraising activities.
- The UBU Project, Event & Volunteer Coordinator/Business, Fundraising & Marketing Consultant, Peoria, AZ, 2017-05, 2024-01, Coordinated multiple fundraising events, including the "Light your corner of the world" benefit concert, 2023, resulting in a 34% increase in community engagement and raising 45% more funds compared to previous years., Recruited and vetted volunteers, including potential Board members, enhancing the volunteer program's efficiency by 18%., Advised Executive Director on best business management practices and marketing techniques, leading to a 76% improvement in organizational processes and marketing outreach
Timeline
Unit Manager Medicare PCP/Transplant/Hospice
Health Care Service Corporation (formerly Cigna Healthcare)
03.2025 - Current
Senior Supervisor, Medicare Enrollment & Eligibility
Cigna Healthcare
07.2024 - 03.2025
Operations Lead Analyst Medicare Enrollment & Eligibility
Cigna Healthcare
06.2021 - 07.2024
Medicare Claims Lead Representative
Cigna Group
03.2020 - 08.2021
Owner/Consultant
ChiroSupport
02.1995 - 12.2015
Bachelor of Science - Healthcare Administration and Management
Colorado State University Global Campus