Byrone Brown JD, MS, CPC, SA

Specialized senior consultant and project manager within the Federal Civilian mission area focusing on areas off operations, change management, policy, data analytics, execution, and strategy. Provide Program and Project Management support to CMS and the Office of Information Technology (OIT).

Achievements:

• Led and facilitated agency change management plan for Million Hearts/Oncology Care Model Electronic File Transfers to IBM Connect and wrote the standard operating procedure.
• Led marketing and communications campaign for the Catalog of Information Technology Tools SharePoint site.
• Facilitated Objective and Key Results Workshop for all Divisions within ESSG Group.
• Led Confluence reorganization and change management efforts for Division of Identity Management Enterprise Systems.
• A founding member and steering committee member of the first Diversity, Equity, and Inclusion Champions League. Developed governance structure and standard operating procedures, strategy, employee resource groups (ERG), and task forces.
• Increased the number of ERGs from 0 to 4 by implementing an ERG task force during fiscal year 2021.
• Improved efficiency and effectiveness of performance and management of processes across departments.
• Evaluated corporate business processes to align outcomes with strategic goals and corporate vision.
• Educated staff on organizational mission and goals to help employees achieve success.

Current Responsibilities:

• Leading corporate level Digital Analytics campaign managing several tasks across each mission area.
• Support the Enterprise Systems and Solutions Group (ESSG) with strategic planning advice and guidance including but not limited to resource needs, stakeholder engagement, decision making, shared service integration, preparation of analytical papers, and as a liaison with the Shared Services team members and component business owners.
• Conduct research and prepare analysis using HCD methodologies.
• Conduct SAFe Agile training.
• Manage project using SAFe Agile best practices.
• Capture and proposal writer, editor, and contributor.
• Design Kanban and scrum boards to manage tasks in Jira.
• Maintain document repositories using Confluence and Jira.
• Manage expectations of service delivery while directing staff to achieve deliverables.
• Develop project plans, analyze level of effort, and ensure timelines and budgets are met.
• Present deliverables to stakeholders during weekly status reports and client meetings.
• Provide feedback and professional development to team members.
• Active participant in professional development opportunities.
• Evaluated impact of process change on overall operation and determined return on investment.
• Responded rapidly to market shifts to make changes to corporate processes.

Cigna is a global health service leader dedicated to helping people improve their health, well-being, and sense of security. My role included establishing client relationships, business development, medical coding and compliance management, healthcare policy review, metric review and tracking, performance improvement, and project management.

Past Achievements:

• Successfully managed a team of coding educators who successfully achieved quarterly metrics.
• Performed root cause analysis which aided Coding Performance Department exceed budget projections for the year (2013-2015) by successfully reinforcing provider engagement within the MA market.
• Helped increase non-engaged provider participation in the 360/HMR program (0% initial participation increased to over 50% active participation).
• Produced written documents, technical updates, and presentations that aided providers improve metrics. Successfully managed the Lumeris platform implementation for providers.
• Successfully trained nurses and physicians in various markets for coding education and compliance.
• Successfully managed 16 + clinicians within MA/DC regarding coding education, auditing, public health programs, and compliance who all met their monthly/yearly goals by significant percentages.

Past Responsibilities:

• Promoted physician engagement within business initiatives including the 360 Wellness Program and the Health Management Report. Experience with EHR systems (NextGen, EPIC, Amazing Charts).
• Developed team/personal goals, training opportunities, evaluation tools, and applied research techniques for various healthcare programs. Versed in provider contracts, RCM, and financial review.
• Analyzed and audited assessments for health program needs, coding accuracy, highest specificity, and supporting documentation for risk management and clinical document improvement.
• Generated reports to identify areas of improvement aligned with provider goals and business targets.
• Subject matter expert on medical coding Hierarchical Condition Categories, HEDIS measures, HIPAA, FWA, HITECH Act, CMS compliance, CAHPS, Risk Adjustment, PCMH, and validation.
• Experience with CPT, ICD-9, ICD-10, HCPCS, Quality assurance and Lumeris implementation.
• Verified client information by analyzing existing evidence on file.
• Communicated effectively with staff members of operations, finance and clinical departments.
• Checked documentation for accuracy and validity on updated systems.
• Acted as medical coding subject matter expert, answering internal and external questions and inquiries.

Cigna-HealthSpring is a leading health services company committed to helping our nation's Medicare and Medicaid beneficiaries live healthier, more active lives through personalized, affordable, and easy- to-use health care solutions.

Past Achievements:

• Successfully created Medicaid claims scenarios using health policy and Medicaid rules for edit inspection and proper adjudication.
• Successfully demonstrated to the Health and Human Service Commission of Texas how to process incoming claims.
• Successfully audited and processed claims with < 5% error rate.
• Successfully reduced claims errors by trending/analyzing data that identified deficiencies.

Past Responsibilities:

• Analyzed claims data, EDI, and Medicaid/ Medicare guidelines, and revenue codes.
• Cross trained to analyze, process and interpret Medicare/DRG Claims.
• Trained new staff on Medicaid/Medicare claims processing.
• Abided by Medicare/Medicaid policies guidelines and 5010 compliance.
• Evaluated original investigation reports and documents to resolve secondary concerns.
• Identified insurance coverage limitations with thorough examinations of claims documentation and related records.
• Viewed reports regularly to make sure processing was conducted efficiently.

Ameritox is the nation's leader in pain medication monitoring, offering urine drug testing services to help physicians assess medication adherence of patients on chronic opioid therapy.

Past Achievements:

• Successfully exceeded/achieved monthly goals.
• Successfully met weekly goals of reducing the amount of outstanding A/R.
• Recouped substantial amounts of revenue pending payment due to denied claims.
• Received positive feedback by subordinates and senior leadership for teamwork capabilities.

Past Responsibilities:

• Worked with customers to develop payment plans and bring accounts current.
• Reviewed billing problems, researched issues and resolved concerns.
• Supervised a team of five employees responsible for the follow up activity and resolution of outstanding accounts and claims.
• Reviewed and conducted trend analysis on aging accounts to determine non-reimbursable claims due inefficient billing practices.
• Responded via written correspondence to patient balances, insurance inquiries regarding account balances, and medical request to substantiate medical necessity.
• Re-processed denied claims for Medicare, Medicaid, and Commercial insurances.