Sandra Tacker Email and Phone Number

Independently manage and maintained high dollar reporting and auditing monthly Zelis Reconciliation report • Analyze and investigate service issues for PPO and Non-PPO networks, including Zelis, PMCS, and UHC overpayments, balance billing, pricing issues/requests, member and provider appeals, and quality assurance issues • Review, analyze, and respond to resolutions from networks and vendors for member/provider inquiries via letters, phone, or internal departments • Served as a liaison for the Transparency Pricing and Coverage process since June 2016, assisting member inquiries regarding individual providers/hospitals with contracted rates and providing fair price quotes • Provide cross-departmental support for the Connection Dental and Network Management UHC teams • Responded to and resolved phone and internet inquiries from members and providers• Served as first level response to high dollar and out of network appeals and escalations

• Research and determine appropriate action to update, maintain, and document information to PPO network utility and Macess system.• Analyze and research service issues, payment issues, member/provider issues related to PPO networks & Non PPO.• Cross trained on Connection Dental, assisted the connection Dental team when the daily issue counts were high.• Liaison for the Transparency process since June 2016. Assist member inquiries regarding individual providers/hospitals with contracted rates and/or provide fair price quotes.

Assisted members and providers with medical, dental, prescription drug, and specialty drug claims and benefit issues • Supported GEHA's contractual provisions in dental (CD and FedVIP) and medical claims, including Medicare, COB, and prescription drugs/specialty drugs • Supported HDHP members with HSA/HRA inquiries and coordinated with the HSA liaison to resolve member issues as well as FEHB and FedVIP, CD members with FSA inquiries. • Aided CCRs with benefit questions, lines of determination, and department policies and procedures while assigned to the Help Desk • Served as first level response to high dollar and out of network appeals, and escalations and cross-trained to assist the Appeals department with correspondence letters and claim adjustments