Byrone Brown JD, MS, SA

Noblis | CMS Office Of Information Technology, Division Of Enterprise Services | January 2019 - Current

• Direct the financial and operational aspects of the $800 K+ contract line-item number for the Division of Enterprise Shared Services Project Management Office, which manages the integration and licensing for Salesforce and SharePoint for CMS
• Oversee cost allocation methodology and budget for the Shared Services
• Develop and implement a Salesforce integration strategy to drive digital transformation, reduce costs, and improve efficiency
• Conduct risk assessment for regulatory and compliance challenges for Shared Services applications
• Direct organizational reorganizational efforts for Shared Services
• Led and collaborated with the Human Centered Design/User Experience team, which used a sentiment analysis tool to improve the operations of the Shared Services PMO team
• Direct tiger teams for business proposals and growth expansion opportunities
• Prepare and present status reports and presentations to executive leaders, including C-suite, group, and division stakeholders
• Develop, track, and monitor objective key results and key performance indicators using JIRA and Confluence
• Developed and implemented contractual, internal, regulatory, and quality compliance controls
• Direct institutional strategy and analysis for Shared Services
• Develop and implement strategies to increase scope and streamline processes
• Lead technical writer for business development proposals, growth opportunities, and strategic advisory services
• Provide mentorship to team members and direct reports
• Direct the project's staffing, scheduling, costs, budget, scope, and time.
  

SR. PRINCIPAL CONSULTANT
Noblis | The Center For Medicare And Medicaid Innovation | January 2017 - January 2019, The Center for Medicare and Medicaid Innovation, Policy, Project

• Developed, led, and implemented the change management strategy for the Million Hearts/Oncology Care Policy Models electronic file transfer to IBM Connect
• Developed a charter for the Comprehensive Primary Care + Change Control Board
• Governed and directed the Million Hearts and Oncology Care Model Change Control Boards
• Developed process improvement strategy for the Change Control Board meetings and collaborated with the development team to automate the business processes using Confluence
• Led the development of the competency center, which improved stakeholder engagement, reduced costs, and streamlined onboarding and change requests at the Change Control Board meetings
• Provide mentorship to team members and direct reports
• Directed and oversaw the project's staffing, scheduling, costs, budget, scope, and time.

PRINCIPAL CONSULTANT
Noblis | CMS, Office Of Information Technology, Enterprise Systems Solutions Group | January 2016 - January 2017, Solutions Group (ESSG) Project

• Led, developed, and implemented a complex change management plan for the Enterprise Agency Shared Services 2.0 (MDM, EIDM, BRES) that orchestrated solutions for reduced costs and enhanced functionality for quicker technology adoption and cost savings
• Identified growth opportunities; developed and implemented an integration agreement that redefined business operations and compliance guidelines between business owners, product owners, shared services, and the change control board
• Directed and co-collaborated with the marketing and communication teams and implemented marketing campaign strategy for Shared Services 2.0
• Developed roadmap for Shared Services 2.0, including, but not limited to, a charter, engagement method SOPs, and agile iteration planning
• Directed and implemented a continuous monitoring and improvement plan, which included a risk management plan
• Analyzed client processes and industry best practices for the CMS SharePoint application and its infrastructure, performed a gap analysis, and presented a compilation report with improvement recommendations to the ESSG Front Office
• Developed and implemented a change management plan to update the CMS Helpdesk standard operating procedures for SharePoint and business tools processes
• Provide mentorship to team members and direct reports
• Directed and oversaw the project's staffing, scheduling, costs, budget, scope, and time.

PRINCIPAL CONSULTANT AND SUBJECT MATTER EXPERT
Noblis | CMS, Office Of Ombudsman | January 2015 - January 2016. CMS Road to ICD-10, Project

• Provided expertise in medical coding, including knowledge of specific coding systems like ICD-9, ICD-10, HCPCS, and CPT codes
• Audited provider coding compliance plans to ensure coding practices were accurate and compliant with, but not limited to, HIPAA, the False Claims Act, the Anti-Kickback Statute, and Medicare and Medicaid Billing regulations
• Audited and evaluated provider documentation for gaps in coding and lack of documentation
• Developed ICD-10 specialty coding presentations and demoed them for participating providers and ancillary staff throughout the United States
• Collaborated with physicians and created process improvement plans, coding resources, and fact sheets for providers
• Communicated status updates via reports directly to the Ombudsman in written and oral reports.

• Supervised and educated providers on how to document hierarchical condition category diagnoses.
• Developed and presented compliance training for providers, including but not limited to HIPAA, Fraud Waste and Abuse, HITECH Act, and coding updates.
• Analyzed physician engagement and compliance in the 360 Wellness HEDIS Program.
• Reviewed HER systems (NextGen, EPIC, Fair Warning Software, Amazing Charts) for wellness program compliance.
• Developed team goals and strategies.
• Identified training opportunities for providers.
• Reviewed provider contracts, revenue cycle management reports, and financial reports for program improvement opportunities.
• Conducted provider training sessions and offered feedback through trend reports, discussing denials and appeals.
• Reviewed and analyzed federal and state laws about Medicare Advantage programs and developed provider education presentations.
• Presented healthcare research and data to external and internal clients through verbal and written reports.

• Analyzed and processed complex high-dollar volume Medicare and Medicaid claims according to regulatory guidelines and coding standards.
• Audited claims included, but were not limited to, revenue codes, procedure codes, diagnostic-related group codes, and diagnosis codes.
• Trained new staff to review and process claims.
• Analyzed electronic data interchange reports and sent action items to the claim's denial team for troubleshooting.

• Supervised team of five employees responsible for resolving claims that were not paid.
• Reviewed and performed trend analysis on accounts again to identify non-reimbursable claims resulting from ineffective billing practices.
• Drafted written response to patient account balances, insurance inquiries regarding these balances, and medical requests to verify medical necessity.
• Reprocessed denied claims for Medicare, Medicaid, and private insurance.

• Verified patient insurance benefits.
• Requested prior authorizations.
• Negotiate vendor contracts.
• Submitted HFCA-1500 insurance claims through online platforms and paper forms.
• Conducted follow-up on insurance status.
• Oversaw financial aspects of the business, including accounting and tax regulations.
• Developed and implemented a business and marketing plan.