Over 25 years of documented claims turnaround, configuration cleanup, provider network enablement, and eligibility work across enterprise payer administration platforms. Founded and led by Gigi Carrabbia. Certified in AI Strategies for Business Transformation: Generative and Agentic Intelligence.
Not consulting theater. Documented operational lift across claims, configuration, provider network, and eligibility. Built inside the operation, not from a slide deck.
When claims backlog is climbing, payment cycle times are slipping, or member and provider abrasion is rising, we come inside the operation and rebuild the workflow.
Bad configuration causes real dollars in leakage and downstream provider network abrasion. We do the SQL-based validation and defect triage work most consultants outsource.
Provider network operations sit between IT, contracting, credentialing, and configuration. We translate strategy into documented operational playbook the team can actually execute on.
Modern eligibility hierarchies, care management operations, and utilization management workflows require both platform expertise and change management. We do both.
Platform migrations fail on the workforce side, not the technology side. We build the training, onboarding, and change communication frameworks that make new platforms actually adopted.
AI applied to claims triage, configuration audit assistance, provider communications, and internal training. The AI is not the pitch. The operational outcome is the pitch. Certified in AI Strategies for Business Transformation: Generative and Agentic Intelligence.
Over 25 years across the major payer platforms. Not "familiar with." Not "have worked adjacent to." Actually configured, migrated, stabilized, and trained on.
Manager, Design, and Admin. Configuration, claims operations, UAT design, cross-platform validation. Enterprise curriculum ownership.
Eligibility hierarchy transformation, care management, authorizations, utilization management, compliance, letters, reporting. Six-level eligibility modernization.
Configuration and claims. Business analyst lead on Cognizant upgrades. SQL and Oracle data extraction, defect analysis, executive reporting.
Business lead role. Post-conversion stabilization. Regression testing and cross-platform validation.
Legacy platform migration experience. SQL crosswalk validation. Regression testing and defect triage during payer system conversions.
5010, 834, 837P, 837I. EFT and payment mapping. Configured EOB logic, GUI payment outputs, CARC and RARC codes. IPPS/MS-DRG, OPPS/APC/APG, RBRVS/FFS, CMG, LTCH, HHPPS, ESRD.
Sanitized case studies from over 25 years leading claims operations, payer platform migrations, and workforce enablement. Numbers are documented and cited to the source engagement.
Reduced 73,000 aged claims to 13,000 under 30 days in six months. Achieved 99% payment processing within 20 days, sustained at 15-day averages. Rebuilt claims training, quality audit, and coding teams. Directed 60+ staff across claims, appeals, correspondence, account management, coding, and quality.
Led coordination of benefits optimization generating $2.5M in savings with 6.1 ROI. Assumed director-level responsibilities during leadership absences. Designed KPIs for adjudication, pends, appeals, recovery, and compliance. Served as business lead for claims administration platforms upgrades with Cognizant.
Modernized digital workplace reducing labor utilization by 35% monthly with $75K Q1 savings. Architected enterprise digital enablement hubs including Learning & Development Communications Site, Change in Motion, and Provider Network Management ServiceNow Center. Modernized workflows, work intake, metadata, prioritization, and governance.
Achieved 96% client savings rate through CCI and NCCI audits, bill review, and reimbursement optimization. Designed hybrid training for appeals and call center teams. Implemented the organization's first full appeals and call center SOP structure. Built appeals aging and prioritization models improving cycle times.
Not an outsider bringing playbooks. Over 25 years INSIDE payer operations. Actually configured core payer administration platforms. Actually stabilized post-conversion claims. Actually rebuilt teams from the ground up.
Cost-to-Revenue Method™ · Operational Translation Sprint™ · Change Impact Crosswalk™. Named frameworks with defined deliverables. Not "our proprietary approach" hand-waving.
Certified in AI Strategies for Business Transformation: Generative and Agentic Intelligence. AI applied where it produces operational lift, not where it looks good on a slide.
Native Spanish, fluent English, bilingual medical terminology. Direct value for Medicare Advantage, Medicaid managed care, and CMS Star Ratings work in bilingual markets.
30 minutes. We use the call to determine whether GGenesis is the right fit for the work you have in front of you. If we are not, we tell you.
30 minutes. Describe your operation, your bottleneck, and what you have already tried. We tell you honestly whether GGenesis is the right fit.