Theresa Pugh
About Theresa Pugh
Theresa Pugh is a Membership Eligibility Data Specialist III at Carelon, where she has worked since 2021. She has a background in health program representation and data management, with previous roles at Anthem and Capital Digestive Care.
Work at Carelon
Theresa Pugh serves as a Membership Eligibility Data Specialist III at Carelon, a position she has held since 2021. In this role, she manages special data loading projects, demonstrating her capability to handle complex tasks. Theresa oversees and coordinates multiple time-critical litigation support activities, ensuring efficient operations. She also mentors and trains team members, contributing to the development of her colleagues. Her responsibilities include troubleshooting receipt and loading issues, which she resolves independently. Additionally, she communicates daily with both internal and external clients to address data production issues, ensuring smooth workflows.
Previous Experience at Anthem
Before joining Carelon, Theresa Pugh worked at Anthem as a Health Program Representative II from 2015 to 2021. During her six years in this role, she was based in Hanover, Maryland. Her experience at Anthem provided her with a strong foundation in health program management and client communication, which she has carried into her current position. This role involved direct interaction with clients and the management of health-related data, enhancing her expertise in the healthcare field.
Experience at Capital Digestive Care
Theresa Pugh was employed at Capital Digestive Care as an EMR Documentation Management Specialist from 2012 to 2015. During her three years in Bowie, Maryland, she focused on managing electronic medical records documentation. This position allowed her to develop skills in data management and compliance, which are essential in her current roles. Her experience in this capacity contributed to her understanding of healthcare documentation processes and standards.
Education and Expertise
Theresa Pugh obtained her Bachelor's degree in Communication and Media Studies from Norfolk State University, where she studied from 1986 to 1990. She is currently pursuing a Bachelor's degree in Health/Health Care Administration/Management at Southern New Hampshire University, a program she has been enrolled in since 2018. Her educational background equips her with strong communication skills and a comprehensive understanding of healthcare administration, enhancing her effectiveness in her professional roles.
Compliance and Audit Control
In her current position, Theresa Pugh ensures adherence to key audit controls and compliance with Department, HIPAA, and SOC standards. Her role requires a thorough understanding of regulatory requirements and the ability to implement processes that maintain compliance. This focus on audit control is critical in the healthcare industry, where data integrity and patient confidentiality are paramount.