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Arica Tanner

@aricatanner

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Experienced healthcare professional specializing in FACETS configuration analysis.

United States

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What I'm looking for

I am looking for a role that values collaboration and innovation, where I can leverage my extensive healthcare experience to drive process improvements and enhance operational efficiency.

I am a dedicated healthcare professional with over 30 years of experience, having progressed from a Medical Claims Examiner to a FACETS Configuration Analyst. My extensive knowledge of FACETS configuration principles, including the data model and various coding systems, has allowed me to excel in roles that require meticulous attention to detail and a deep understanding of healthcare operations.

Throughout my career, I have received consecutive outstanding evaluations for my efficient performance and professionalism. I have successfully led teams in implementing provider pricing initiatives and conducting root cause analyses to identify operational improvements. My ability to mentor lower-level analysts and collaborate with stakeholders has contributed to the success of various projects, ensuring that business needs are met while maintaining high standards of quality and accuracy.

Experience

Work history, roles, and key accomplishments

Current

Functional Analyst III

Current

CareFirst BCBS

Aug 2022 - Present (3 years)

Prepares to implement provider pricing by analyzing supporting documentation and determines appropriate methodology. Conducts root cause analysis to identify efficiencies and opportunities for improvement.

Root Cause Analysis Business Needs Procedural Guidelines Cost Benefit Analysis Process Improvement Data Analysis Trend Analysis

Lead Business Analyst

CareFirst BCBS

Mar 2015 - Present (10 years 5 months)

Responsible for the overall success of user acceptance testing and validation, including test scenario case documentation, testing execution, verification, and release. Implemented practices and procedures for end-user test plans.

User Acceptance Testing Test Case Documentation Test Execution Verification)Release Management Test Plans Gap Analysis Training Project Planning Documentation Troubleshooting Risk Mitigation Quality Assurance

Senior Business Analyst

ALTEK Information Technology

Sep 2014 - Present (10 years 11 months)

Served as a liaison between the internal/external business community and the IT organization to provide technical solutions to meet user needs. Gathered information about the organization's work processes and information for Summary of Benefits Coverage (SBC).

Business Analysis Liaison Technical Solutions Market Analysis Issue Tracking Resolution Planning Technical Communication Integration Testing User Acceptance Testing System Deficiencies Solution Recommendation

Claims Resolution Analyst

High Point Solutions

May 2014 - Present (11 years 3 months)

Reviewed and resolved call and web inquiries received from Client Services and Provider Relations Teams via the Pega Workflow system. Processed COB claims for commercial and Medicare clients in FACETS and XCELYS Operating Systems.

Facets Subscriber Member Application Group Limit Rules Product Medical Plan Application Group Provider Network Status Medical Claims Allowed Amounts Disallowed Amounts Cigna Multiplan Billing Application Group Payment History Pricing NetworX Application Group Manual Payment Reductions Accounting Application Group Case Management

QNXT Configuration Analyst

Simply Health Care

Feb 2014 - Present (11 years 6 months)

Interpreted Schedule of Medicaid/Medicare Benefits, EOC's and converted them to configuration parameters. Maintained thorough documentation for tracking all benefit/provider configuration changes.

QNXT Configuration Medicare Benefits EOC Conversion Configuration Benefits Configuration Analysis Team Collaboration Training Technical Direction Liaison Troubleshooting Benefit Related Issues

ICD-10 Implementation Specialist

BLUE CROSS BLUE SHIELD

Jun 2012 - Present (13 years 2 months)

Configured ICD-10 codes on SPCT and SRCT tables within FACETS. Collaborated directly with clients to ensure ICD-10 implementation optimized their needs.

ICD 10 Coding SPCT Tables SRCT Tables Facets Implementation Research Documentation Troubleshooting User Acceptance Testing Project Coordination

Sr. Technical Consultant

High Point Solutions

Jan 2012 - Present (13 years 7 months)

Assisted with FACETS Assessment and assessed FACETS Application Processing Control Agent (PCA) and CSP Platform. Gathered requirements to formulate business process specifications and translated them into application functionality.

Facets Application Processing Control Agent (PCA)CSP Requirements Gathering Business Specifications Business Needs Issue Tracking Resolution Planning Business Processes

Sr. Technical Consultant

UNITED HEALTHCARE

Jan 2012 - Present (13 years 7 months)

Configured Provider agreements and fee schedules for Delaware. Identified and implemented effective configuration solutions within FACETS 4.71.

Provider Operations Project Specialist

BRAVO HEALTH PLAN

Nov 2009 - Present (15 years 9 months)

Supported the Network Management department and its efficiency through the management of standard credentialing processes and projects. Focused on Provider data validation for Delegated and IPA Providers through Provider communications development and credentialing.

Network Management Credentialing Project Management Data Validation IPA Providers Billing Address Verification Service Location Verification Phone Number Verification Provider Data File Review

FACETS Configuration

KEYSTONE MERCY HEALTH PLAN

Jul 2002 - Present (23 years 1 month)

Used expert knowledge of FACETS System in identifying root cause problems to make recommendations regarding how FACETS can be reconfigured to solve issues and/or increase efficiencies. Possessed practical knowledge of FACETS configuration principles and activities, including the FACETS data model.

Claim Technical Advisor

KEYSTONE MERCY HEALTH PLAN

Jan 1999 - Present (26 years 7 months)

Mediated between the Health Plan, the State, Informational Services, and Claims Processing to implement new lines of business. Maintained member benefits, provider contracts, fee schedules, and reference files used in claim processing.

Claim Technical Advisory Health Plan Mediation Information Services Claims Processing Health Plan Contracts State Fee Schedule Reference Files State Claims Processing

Provider Claim Service Representative II

KEYSTONE MERCY HEALTH PLAN

Jan 1996 - Present (29 years 7 months)

Delivered immediate responses to incoming calls regarding claim status or adjudication. Performed online corrections and timely/accurate resolutions to provider appeals and disputes, including comprehensive documentation of problem causes and steps taken to resolve.

Provider Claim Service Claim Adjudication Internal Systems External Systems

Quality Review Analyst

KEYSTONE MERCY HEALTH PLAN

Jul 1992 - Present (33 years 1 month)

Functioned as a technical specialist for claims enhancements operations. Analyzed complex operational claim payments problems and provided technical solutions.

Claim Payment Problems Technical Solutions Health Plan Inquiries Claim Input Appeals Revaluation Payment Timeliness Outpatient Claims Emergency Claims Short Procedure Unit Claims

Education

Degrees, certifications, and relevant coursework

Trizetto

Certification, Healthcare IT

Obtained certification from Trizetto, demonstrating expertise in relevant healthcare IT systems and applications. This certification enhances capabilities in managing and configuring healthcare data systems.

ML King High School

High School Diploma, General Studies

Activities and societies: Academic Achievement

Achieved academic recognition at ML King High School, focusing on foundational subjects. This period established a strong educational base for future professional development.