Summary
Overview
Work History
Education
Skills
Personal Information
Timeline
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Tina Green

Houston,Texas

Summary

Results-driven Payment Integrity Professional specializing in healthcare payer operations and claims analysis. Achieved enhanced payment accuracy through effective translation of payment integrity requirements into actionable configuration specifications and rigorous testing. Focused on strengthening operational controls and improving claims adjudication processes by collaborating with business and technical teams to resolve requirement gaps.

Overview

13
13
years of professional experience

Work History

Payment Accuracy Advisor (Six-Month Contract)

Lyric
Houston, TX
03.2026 - 08.2026
  • Defined business and functional requirements for ClaimsXten payment integrity edits supporting Aetna and Humana; translated payment-policy needs into configuration logic and testable rules.
  • Built and maintained payment integrity configurations using procedure codes, modifiers, age bands, tax IDs, and exclusion criteria to support accurate adjudication outcomes.
  • Partnered with payer stakeholders, claims operations, and technical teams to assess workflows, resolve requirement gaps, and align configuration decisions with real claim scenarios.
  • Validated client builds and payment integrity edit logic through test claims; analyzed outcomes, identified defects, and recommended configuration adjustments.
  • Facilitated Medicaid and commercial updates by validating requirements, conducting UAT, triaging defects, and ensuring release readiness and post-implementation payment validation.
  • Developed process flows and implementation documentation; communicated risks, dependencies, and decisions to stakeholders, enhancing controls and production readiness.
  • Worked remotely to support team collaboration and project completion.

Payer Contract Modeling Contractor

Elevate PFS
Houston, TX
06.2025 - 02.2026
  • Interpreted complex payer agreements to produce accurate contract-modeling specifications for reimbursement terms, rates, carve-outs, and contract provisions.
  • Collaborated with stakeholders to resolve discrepancies in contract language or source data, ensuring documented decisions maintained downstream payment accuracy.
  • Managed multiple concurrent modeling assignments and deadlines by tracking dependencies, anticipating obstacles, and providing concise progress and risk updates.
  • Validated database entries and conducted quality reviews to ensure accurate representation of contract terms prior to advancing work to downstream teams.

Manager, Claims Analysis & Remediation

Optum/United Healthcare
Houston, TX
08.2019 - 03.2025
  • Led claims and benefits remediation for new business, supporting payment integrity by identifying claim-processing and benefit-configuration errors and developing corrective action plans.
  • Aligned claims operations, business partners, and technical teams on root causes and configuration corrections to enhance accurate claims adjudication.
  • Conducted pre- and post-remediation analyses to validate claim outcomes, verify corrections, and identify remaining payment integrity and quality risks.
  • Transformed operational gaps into actionable business requirements and workflow improvements while documenting scope, decisions, risks, and implementation priorities.
  • Translated operational gaps into business requirements, workflow improvements, and leadership recommendations; documented scope, decisions, risks, and implementation priorities.
  • Coached analysts and coordinated high-priority remediation work, ensuring consistent documentation, quality reviews, and effective communication across stakeholder teams.

Senior Claims Business Analyst

Optum/United Healthcare
Houston, TX
01.2014 - 07.2019
  • Gathered business and functional requirements for claims, benefits, and authorization initiatives across Medicaid, Medicare, commercial, medical, and behavioral health products to enhance service delivery.
  • Gathered business and functional requirements for claims, benefits, and authorization initiatives across Medicaid, Medicare, commercial, medical, and behavioral health products.
  • Developed test strategies and coordinated UAT for system and workflow changes; evaluated claim scenarios, analyzed results, and communicated defects and release recommendations.
  • Collaborated with case management, behavioral health, early intervention, and Medicaid partners to coordinate complex cases and streamline resolution of workflow barriers.
  • Prepared reports, presentations, and status updates that translated technical findings into actionable insights for stakeholders.

Education

Bachelor of Science - Human Services

University of Phoenix
Phoenix, AZ

Associate of Science - Healthcare Administration

University of Phoenix
Phoenix, AZ

Skills

  • Claims configuration
  • Benefit configuration
  • UAT, Edit Validation & Defect Triage
  • Functional requirements
  • Functional Expertise: Payment integrity, claims adjudication, payment edit configuration, benefit configuration, payer contract modeling, requirements analysis, process mapping, auditing, root-cause analysis, implementation support, change management
  • Payer Stakeholder Collaboration
  • Process improvement
  • Platforms & Analytics: ClaimsXten, Tableau, Power BI, Orbit, SQL (in progress),FACETS, CSP FACETS, Microsoft Excel, PowerPoint, SharePoint, JIRA, Clarity
  • Healthcare: Medicaid, Medicare, commercial, medical, and behavioral health claims

Personal Information

Title: Healthcare Business Analysis | Payment Integrity | Claims Configuration

Timeline

Payment Accuracy Advisor (Six-Month Contract)

Lyric
03.2026 - 08.2026

Payer Contract Modeling Contractor

Elevate PFS
06.2025 - 02.2026

Manager, Claims Analysis & Remediation

Optum/United Healthcare
08.2019 - 03.2025

Senior Claims Business Analyst

Optum/United Healthcare
01.2014 - 07.2019

Bachelor of Science - Human Services

University of Phoenix

Associate of Science - Healthcare Administration

University of Phoenix
Tina Green