Tanya L. Milledge
Columbia
Summary
Skilled in project management, communication, and conflict resolution, with a proven ability to lead teams and drive process improvements. Adept at analyzing complex data and implementing strategic enhancements to improve efficiency and quality.
Diligent Desired Position with background in managing complex projects across various industries. Known for successfully leading cross-functional teams to deliver projects on time and within scope. Demonstrated ability to manage project lifecycles and implement process improvements.
Overview
27
27
years of professional experience
Work History
Project Manager
BlueCross BlueShield of SC
Columbia, SC
06.2024 - Current
- Lead planning and implementation of I/S testing projects to include coordinating the development and implementation of project and procedural enhancements, data gathering, process analyses, procedural documentation, leading development teams, training management and non-management staff, and establishing processes to monitor and sustain effective changes.
- Facilitate the definition of project missions, goals, tasks, and resource requirements, service levels and customer requirements. Communicate with information systems and internal staff related to project assigned. Provide continuity between groups through attendance and participation in work sessions, scope and design walkthroughs and weekly status meetings.
- Manage project budget and resource allocation. Administer scheduling, planning, reporting, development and implementation within timelines and budgets. Provide technical and functional assistance to project team members during all project phases.
- Function as lead in reviewing proposed enhancements and identifying issues related to project business requirements. Resolve or assist in the resolution of conflicts within and between projects or functional areas. Direct testing and coordination of changes/enhancements. Oversee the development of test matrices and coordination of internal and external personnel for testing implemented changes.
- Provide training and documentation for customers and staff related to project status, procedures and changes. Provide education and training regarding policies and procedures that are changed or developed because of changes and projects. Generate internal and external reports to support management in determining productivity and efficiencies of programs or operational processes. Analyze processes to ensure accuracy and quality. Make recommendations to improve processes and drive efficiency in quality. Assist in the identification of potential cost savings. Complete other tasks as assigned by management.
Senior Operations Analyst
BlueCross BlueShield of SC
Columbia, SC
06.2023 - 06.2024
- Researched and analyzed data that has a vital impact on the success of the operation, program, or project and that is used for developing operating strategies.
- Developed detailed test plans and documented test data based on specifications.
- Conducted testing and relayed results. Guided senior analysts with testing activities.
- Defined and analyzed quality assurance metrics such as defects, counts, test results and status, to ensure work is free of errors.
- Participated with other areas on special projects and committees to improve testing quality.
- Under general direction, defined business requirements, tests, and lead small to moderate projects. Assisted management in performing business reviews by analyzing internal/external projects and changes. Ensured changes do not have a negative impact on productivity and procedures. Made recommendations to improve productivity, cost effectiveness and timeliness.
- Communicated with management and departmental personnel to document workflow procedures. Assisted in preparing verbal and written communication about business changes with management or other staff members.
Grievance and Appeals Specialist
BlueCross BlueShield of SC
Columbia, SC
07.2022 - 07.2023
- Logged, tracked, and ensured completions of all Medicare Advantage appeals, direct member reimbursements and grievance cases in compliance with CMS standards.
- Managed tracking database to ensure integrity of data and that all assigned cases are captured and maintained appropriately.
- Prepared documentation and transmitted Medicare Advantage appeals of clinical denials to the appropriate professional for review and tracking review completion to ensure final closure of the associated case.
- Participated in all aspects of the Medicare Advantage direct member reimbursement, grievance & appeal process, specifically intake, triage, coordination, and documentation.
- Researched, investigated and resolved administrative aspects of Medicare Advantage appeals and/or grievances from CMS members and related outside agencies utilizing systems, clinical assessment skills, knowledge and approved 'Decision Support Tools' in the decision-making process regarding health care services and care provided to members.
- Assured accurate, timeliness and appropriateness for all Medicare Advantage grievances and appeals according to state and federal and CMS guidelines.
- Collaborated with internal departments as necessary (Customer Service, Provider Services, Quality, Claims, Utilization Management, and others to ensure the timely resolution of all grievances and appeals.
- Documented the results of Medicare Advantage complaints and appeals and dispositions at all levels, including notification to providers and members.
- Prepared and determined appropriate language for Medicare Advantage letters and prepare responses for all appeals and grievances.
Staff Accountant/Office Manager
Commercial Metals Company
Lexington, SC
03.2022 - 07.2022
- Assisted Operations Manager in maintaining an accurate inventory with no losses due to fraud, poor quality control, poor operational or accounting practices.
- Managed purchase orders (PO) for various outside vendors, etc. and tracks until paid.
- Assisted with resolving complex PO vs Invoice reconciliations.
- Maintained vendor accounts by submitting invoices for payment and reconciling vendor files.
- Knowledge of broad range of business processes in a complex company (e.g., Inventory, Fixed Assets, Payroll, Procurement, Sales, Security, etc.)
Accounting (A/P) Manager
Turbeville Insurance Agency
Columbia, SC
03.2019 - 03.2022
- Completed payments and controls expenses by receiving, processing, verifying, and reconciling invoices.
- Reconciled processed work by verifying entries and comparing system reports to balances.
- Maintained accounting ledgers by verifying and posting account transactions.
- Verified vendor accounts by reconciling monthly statements and related transactions.
- Maintained historical records by microfilming and filing documents.
- Protected organization’s value by keeping information confidential.
Accountant/Fiscal Analyst II
SC Department of Mental Health
Columbia, SC
05.2018 - 12.2018
- Coordinated all activities related to the practitioner enrollment process. Completed all paperwork required to enroll, terminate, or add location for billing purposes.
- Reviewed superbills for problems. Returned unacceptable superbills to facilities. Ensured superbills are being keyed in a timely manner.
- Updated charges annually from Medicare Fee schedules. Coordinated with IT to have new CPT/HCPCS/ICD9/10 codes added to Avatar.
- Reconciliation with DIS on uncompensated care. DDSN billing outside charges.
- Assisted Director with special projects as needed. Gather and organize data as needed for projects.
Management and Supervision
BlueCross BlueShield of SC
Columbia, SC
07.2017 - 05.2018
- Ensured timely and accurate sorting and distribution of claims and written correspondence.
- Interviewed, selected, developed, motivated, compensated and deployed staff. Maintain all job descriptions and desk procedures.
- Ensured compliance with contractual performance measures. Ensured consistent application of management controls.
Auditing/Accounting
BlueCross BlueShield of SC
Columbia, SC
02.2016 - 06.2017
- Reviewed all invoices for appropriate documentation and approval prior to payment.
- Keyed invoices or check requests in a timely manner.
- Responded to vendor or department inquiries and checked accounting transactions to resolve discrepancies.
- Sorted and distributed incoming mail.
- Matched invoices to checks, obtained all signatures for checks and distributed checks accordingly.
- 1099 maintenance.
- Responded to all vendor inquiries.
- Assisted in month end closing.
- Maintained files and documentation thoroughly and accurately, in accordance with company policy and accepted accounting practices.
Customer Service Claims Supervisor
BlueCross BlueShield of SC
Columbia, SC
08.2015 - 01.2016
- Monitored workflows to ensure accurate and timely processing of medical, dental, or vision claims, minimizing backlogs.
- Reviewed and resolved escalated or complex claims, including denied claims and disputed coverage issues.
- Compiled and analyzed monthly reports on claims data to identify trends, enhance revenue collection, and improve operational efficiency.
Associate Team Member II
BlueCross BlueShield of SC
Columbia, SC
12.2013 - 01.2015
- Supervised, monitored, tracked and directed day-to-day operations to staff.
- Provided expertise and/or general claims support teams in reviewing, researching, negotiating, processing and adjusting Medicare claims.
- Consistently met established productivity, scheduled adherence, and quality standards.
- Recruited, interviewed, and hired team members, took discipline action, motivated and trained.
- Interpreted and applied policies and procedures within health care operations.
- Created and revised claims verbiages and desk procedures to ensure Medicare claims are processed correctly and timely.
Associate Team Member II
Palmetto GBA Region C
Columbia, SC
02.2002 - 09.2009
- Perform in-depth review of resolved claims, membership processing, and customer inquiries. Verified claims payment, guidelines, and customer service administration are following BCBS, government guidelines and contractual contracts.
- Analyzed for correct system adjudication and fraud.
- Provided audit findings for external auditors i.e., Office of Insurance Service, Blue Cross Association, Blue Choice Health Plan, Ernst & Young, and SAS 70 Report.
- Calculated dollars paid in error and projection of monies paid incorrectly throughout the claims population. This provides the necessary controls to reduce waste and costs in operations area.
Sales Associate
Sears
Columbia, SC
04.1999 - 02.2002
- Responded accurately and timely to telephone, written and walk-in inquiries from customers.
- Processed appeals that required re-examination of previously processed claims.
- Identified and reconciled any errors in our system that may have occurred in the managing and maintaining of our members, including the upkeep of their personal health information, plan options and billing information.
- Completed research to initiate and coordinate activities required in resolving customer issues in an accurate, prompt and courteous manner.
- Researched escalated enrollment issues coming through support line and department email box.
Education
Associate in Accounting - Accounting
Midlands Technical College
Columbia, SC05.2011
Associate in Arts (A.A.) - Arts
Midlands Technical College
Columbia05.1999
Skills
Project management
Strong Analytical
Communication
Teamwork
Leadership
Problem-solving
Time management
Adaptability
Emotional intelligence
Conflict resolution
Attention to detail
Team leadership & development
Client relationships
Integrity and honesty
MS office
Analytical thinking
Strategic planning
Issue resolution
Customer relationship management
Project leadership
Goal setting
Continuous improvement
Work Planning and Prioritization
Project implementation
Analysis & evaluation
Best practices implementation
Organizational development
Timeline
Project Manager
BlueCross BlueShield of SC
06.2024 - Current
Senior Operations Analyst
BlueCross BlueShield of SC
06.2023 - 06.2024
Grievance and Appeals Specialist
BlueCross BlueShield of SC
07.2022 - 07.2023
Staff Accountant/Office Manager
Commercial Metals Company
03.2022 - 07.2022
Accounting (A/P) Manager
Turbeville Insurance Agency
03.2019 - 03.2022
Accountant/Fiscal Analyst II
SC Department of Mental Health
05.2018 - 12.2018
Management and Supervision
BlueCross BlueShield of SC
07.2017 - 05.2018
Auditing/Accounting
BlueCross BlueShield of SC
02.2016 - 06.2017
Customer Service Claims Supervisor
BlueCross BlueShield of SC
08.2015 - 01.2016
Associate Team Member II
BlueCross BlueShield of SC
12.2013 - 01.2015
Associate Team Member II
Palmetto GBA Region C
02.2002 - 09.2009
Sales Associate
Sears
04.1999 - 02.2002
Associate in Accounting - Accounting
Midlands Technical College
Associate in Arts (A.A.) - Arts
Midlands Technical College