Theresa (Terri) Hughes

Auditing CMS (Center for Medicare and Medicaid) QHP (Qualified Health Care) templates for all IFP (Individual and Family Plans) states.

Auditing SBCs (Summary of Benefits ans Coverage) for all IFP states.

Training new and current team members.

Managing QHP templates being loaded for OLQ (On-line Quoting) partners.

Building SBC templates in our vendor HighRoads system to implement automation of SBCs.

Loading all Off Exchange templates in the HIOS (Health Insurance Oversight System)/RBIS (Rates and Benefits Information System) systems for all IFP states in order for IFP plans to be available for consumers to view and compare plans on HealthCare.gov.

Uploaded all IFP States SBCs to Filenet to be available on MyCigna.com.

Uploaded all IFP States SBCs to onBase to be available for Customer Service Representatives.

Primarily responsible for completing CMS QHP Plans and Benefits template for Individual and Family plans related to the ACA.
Create Individual and Family plans SBCs (ACA required employee Summary of Benefits and Coverage).
Load information to HPS (Health Partner Systems) for our consumer viewing.
Perform benefit audits of our OLQ (On-line Quoting Partners) partners.
Maintain MAS (Master Account Structure) document which contains an abundance of information used by downstream areas such as Pro duct and Facets.

Act as the ongoing expert regarding client plan interpretation.
Update Employer Benefit Summaries and maintain updates.
Review Client or Sales produced Benefit Summaries against ePro and source documents for benefit accuracy.
Apply legislation to Employer Benefit Summaries.
Review benefits for Essential Health Benefits and ACA compliance.
Create SBCs (ACA required Summary of Benefits and Coverage).
Responsible for more than 50 Regional and National Accounts.

Attended Internal and External Implementation meetings.

Responsible for maintaining a complex book of business and providing any benefits and administrative related information for clients and internal matrix partners on specific accounts.
Served as a technical resource to assess the feasibility of requested plan designs.

Responsible for loading Medical and Dental Benefits into BIDS to be reflected in Benefit Access in order to allow accurate benefit quoting for the National Account Segment.
Attend Expert Team meetings.
Worked on the Compare Tool Project.

Auditing Benefits Access.

Responsible for accurate loading of medical benefits into the Medicom and PHMS claim systems.
Attend Expert Team meetings to help implement new and existing cases.
Assist in daily managerial responsibilities in manager's absence.

Monitored, recorded and adjusted Claim Processors defects.
Reviewed and adjusted medical claims and audited medical files.
Interpreted legislation as it pertains to the medical insurance industry.
Served on numerous committees to develop and promote efficiency along with productivity.

Processed and approved medical claims for payment.
Analyzed and researched medical plans to determine correct benefits.
Served as Team Leader.
Strong ICD-9 and CPT coding knowledge.