Alexis Martin
Rossville
Summary
Detail‑driven healthcare operations and configuration specialist with 8+ years of experience in claims processing, quality audit, Medicare AR, and cross‑functional issue resolution. Proven ability to analyze root causes, validate system outputs, streamline workflows, and maintain high‑accuracy performance in fast‑paced, regulated environments. Strong communicator skilled in documentation, process improvement, and supporting team development. Adept at managing multiple priorities, resolving complex issues, and ensuring operational readiness for production‑impacting work.
Overview
16
16
years of professional experience
1
1
Certification
Work History
Medicare Accounts Receivable Specialist
HCSC (Cigna Healthspring)
01.2023 - Current
- Conduct detailed root cause analysis on claim and payment discrepancies, ensuring accurate resolution and preventing recurrence.
- Validate system‑generated outputs and resolve open AR issues
- Provide clear policy‑aligned education to providers, strengthening understanding of Medicare requirements and internal workflows.
- Consistently exceed service level expectations through strong organization, accuracy, and timely follow‑through.
- Maintain precise documentation of issues, decisions, and resolutions to support audit readiness and operational transparency.
Quality Review & Audit Lead
Cigna Healthcare
09.2020 - 12.2022
- Led quality reviews and audits to ensure accurate, compliant claim submissions across multiple product lines.
- Identified trends, defects, and workflow gaps, recommending process improvements that reduced rework and strengthened internal controls.
- Provided coaching and peer mentoring to improve team accuracy, consistency, and technical execution.
- Collaborated with cross‑functional partners to resolve escalated issues and support operational readiness for new processes.
Claims Senior Representative
Cigna Healthcare
03.2017 - 09.2020
- Managed complex, high‑visibility accounts (NFL, HCA), ensuring accurate adjudication aligned with policy provisions and regulatory requirements.
- Executed end‑to‑end claim processing, including validation, documentation, and issue resolution.
- Participated in special projects requiring strong analytical skills, system navigation, and cross‑team coordination.
- Maintained a 95%+ quality score, demonstrating consistent accuracy in a high‑volume, fast‑paced environment.
- Processed diverse claim types (office visits, inpatient/outpatient hospital, behavioral health, oncology, dental, home health), strengthening multi‑system proficiency.
Clerical and Imaging Representative
Chattanooga Imaging
05.2016 - 10.2016
- Verified insurance and billing information with high accuracy during patient intake.
- Educated patients on coverage details while maintaining exceptional service standards.
- Coordinated scheduling and ensured accurate, organized medical records for radiologist review and Tumor Board presentations.
Customer Service Specialist
Blue Cross Blue Shield of TN
07.2010 - 05.2016
- Delivered comprehensive plan education to members, brokers, and providers, ensuring clear understanding of benefits and reimbursement.
- Communicated claim outcomes and financial responsibilities with clarity and professionalism.
- Recognized for consistent service excellence and strong problem‑solving skills.
Education
Associate of Business Administration - Business
Chattanooga State Community College
Chattanooga, TNHigh School Diploma -
Hixson High School
Hixson, TNSkills
- Root cause analysis & issue resolution
- Process improvement & workflow optimization
- Cross‑functional collaboration
- High‑accuracy data entry
- Testing, documentation & audit readiness
- Provider communication
- Mentoring & knowledge sharing
Certification
- Certified Professional Coder (CPC)-AAPC
Timeline
Medicare Accounts Receivable Specialist
HCSC (Cigna Healthspring)
01.2023 - Current
Quality Review & Audit Lead
Cigna Healthcare
09.2020 - 12.2022
Claims Senior Representative
Cigna Healthcare
03.2017 - 09.2020
Clerical and Imaging Representative
Chattanooga Imaging
05.2016 - 10.2016
Customer Service Specialist
Blue Cross Blue Shield of TN
07.2010 - 05.2016
Associate of Business Administration - Business
Chattanooga State Community College
High School Diploma -
Hixson High School