TAMMY MARBLE
Sparta,MI
Summary
Senior Healthcare Business Analyst with 25+ years of experience supporting claims adjudication, healthcare operations, and TriZetto FACETS platforms. Expertise in requirements gathering, process improvement, claims lifecycle management, root cause analysis, UAT, and cross-functional stakeholder collaboration. Proven ability to optimize claims processing workflows, improve operational performance, and support Medicare, Medicaid, and commercial healthcare programs.
Overview
30
30
years of professional experience
Work History
SENIOR MEDICARE CLAIMS COORDINATOR
PRIORITY HEALTH
Grand Rapids, MI
06.1996 - Current
- Led analysis and resolution of complex claims adjudication issues within FACETS, reducing claim pends and improving turnaround times.
- Conducted root cause analysis on high-volume claim defects, identifying workflow improvements that increased auto-adjudication rates.
- Developed and executed UAT test plans for FACETS and Epic claims implementations and system upgrades, ensuring alignment with project objectives.
- Partnered with business and technical teams to gather requirements and document BRDs, leading to successful implementation of claims processing enhancements.
- Analyzed claims operational metrics to support performance improvement initiatives.
- Facilitated cross-functional process redesign efforts resulting in improved claims accuracy with a 95% success rate.
- Supported EDI claims transactions (837/835) and HIPAA compliance initiatives.
- Managed issue tracking, validation testing, and monitoring for claims-related projects to ensure successful implementation.
Education
CERTIFICATION - MEDICAL CODING
AAPC
Skills
- FACETS processing
- Claims adjudication
- Claims processing enhancements
- UAT testing
- EDI transactions
- HIPAA compliance
- Root cause analysis
- Claims analytics
- Problem solving
- Attention to detail
- Cross-functional collaboration
- Effective communication
Timeline
SENIOR MEDICARE CLAIMS COORDINATOR
PRIORITY HEALTH
06.1996 - Current
CERTIFICATION - MEDICAL CODING
AAPC