Krista Lehm
Director of Medicare Advantage Provider Data Operations @Cigna Healthcare
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WORK HISTORY
Director of Medicare Advantage Provider Data Operations @Cigna Healthcare
Contribute directly to successful Annual Enrollment Periods through ensuring provider loads needed for adequacy and marketability are completed within provider directories and HSD tables. Automated data ingestion which reduces the manual processing previously required. •Centralized the creation of HSD tables through transferring data from spreadsheets held in each market into a centralized database. Caused a reduction in data errors as well as allowed for an oversight program for Network Adequacy. Continuing to improve process through the use of automation. •Enhanced the functionality of the online provider directory which directly impacted and reduced the number of grievances received around the usability of the online provider directory. Continuing to enhance and augment the tool over time in order to remain customer centric as well as maintain compliance with federal, states, and NCQA requirements. •Vendor management for organizations supporting Cigna efforts to outreach to providers and improve provider data accuracy. Contributed directly to the direction and roadmap of these vendors through participation in workgroups and advisory boards that included multiple health plans in the industry.•Developed and successfully implemented provider data quality improvements and the maintenance of these rules which has resulted in a 50% reduction in data quality errors. •Maintenance of provider directory and HSD table databases which includes but is not limited to maintaining and adjusting the data model as needed to satisfy federal, state, and NCQA requirements, creating automated processes to ingest provider data, and instituting version control•Increased efficiency and decreased operating expenses through automation of national vendor and Anderson provider data into provider directories.•Leading numerous strategic projects to increase the accuracy and quality of the data contained in provider directories.
EDUCATION
University of Delaware
BA, Psychology
Goldey-Beacom College
M.B.A, Finance, Marketing
SKILLS
ABOUT KRISTA LEHM
Broad background in the finance and healthcare industries. Responsibilities have ranged…
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