Tawanna Nichols
Atlanta,GA
Summary
Versatile Business Operations Specialist with background in optimizing operational processes and implementing effective business solutions. Skilled in systems analysis, stakeholder engagement, and process improvement, consistently delivering results that drive efficiency and reduce costs. Strong analytical abilities and problem-solving skills contribute to successful project outcomes and positive impacts on overall business performance.
Overview
19
19
years of professional experience
1
1
Certification
Work History
Senior Consultant
South Carolina Department of Health and Human Services (SCDHHS)
Columbia, SC
12.2014 - Current
- Reconciled complex system issues for beneficiaries and health plans involving CMS, MMIS, MAXIMUS, and MES systems as subject matter expert.
- Served as liaison for Managed Care Organizations and Medicare Advantage Plans, providing administrative and technical support for program planning and evaluation.
- Collaborated with Medicaid’s Eligibility, Community Long-Term Care, Nursing Facility partners, and Ombudsman’s Office to conduct trainings and enhance care understanding.
- Supported executive management in achieving Medicare-Medicaid policy goals and meeting implementation timelines for federal demonstration projects.
- Created reports for stakeholders including CMS, Director of Medicaid, beneficiaries, providers, and state vendors to ensure transparency.
- Drafted business requirements and partnered with project management team to implement compliance changes with CMS federal guidelines.
- Educated providers while establishing communication with nursing homes, rehab facilities, case managers, and other healthcare providers.
- Managed contract monitoring for enrollment broker's contract to ensure adherence to program deliverables.
Adult Education and Family Literacy Act (AEFLA) Grant Reviewer “Contractor”
South Carolina Department of Education/Office of Adult Education (SCDE/OAE)
Columbia, SC
06.2021 - 07.2021
- Evaluated program abstracts, narratives, and application budgets based on qualitative criteria.
- Rated each grant proposal’s submission based on information provided compared to a scoring rubric.
- Justified ratings with written comments on the acceptability of the applicant’s responses.
Electronic Data Specialist
AFLAC Group Insurance
Columbia, SC
11.2012 - 12.2014
- Compared electronic enrollment data to established enrollment guidelines and requirements.
- Reviewed enrollment documents for accuracy and concurrence.
- Set up benefit plans, products and underwriting in Trac G system for enrollment files.
- Uploaded enrollment data to Genelco for production.
- Tested electronic enrollment files for positioning and formatting errors.
- Served as team lead for new employees.
- Identified premium, billing and eligibility discrepancies on files.
- Provided immediate support to new employees including onboarding, oversight, and delegating daily tasks.
- Edited census files and enrollment files in text and excel for upload.
- Approved test files prior to being loaded into the production environment.
Business Analyst II
Blue Cross Blue Shield, Palmetto GBA
Columbia, SC
11.2011 - 11.2012
- Reviewed and validated supplier bids for federal contracts in national Medicare Competitive Bidding Program.
- Evaluated existing processes and procedures and make recommendations for improvement.
- Created business resource tools and databases that streamline research and optimize time efficiency.
- Generated data to prepare reports and maintain databases for various projects.
- Completed special projects and inform management of any quality issues.
- Tested work processes and procedures for accuracy, simplification, and practicality.
- Lead educational development training sessions for new employees.
- Verified licensure and accreditation for suppliers in federal program in accordance with the Centers for Medicare and Medicaid Services.
Enrollment Technology Analyst II
Colonial Life Insurance
Columbia, SC
11.2005 - 08.2010
- Resolved issues resulting from technical insufficiencies and user error and recorded call details with software tracking.
- Drafted detailed reports for administrators and brokers.
- Assisted with knowledge transfer with regard to database features, tools, and utilities.
- Tested enrollment platform functionality, performance and interface practicality and quality.
- Consulted with brokers and agents on enrollment strategy and implementation of enrollment needs.
- Assisted customers with online self-enrollment login, password resets, and enrollment.
- Provided technical leadership and customer support for in-field agents using excellent problem-solving skills.
- Served as a liaison to IT, Account Services, Compensation, and other departments to create more efficient processes for clients.
- Analyzed clients’ database designs and structures for optimal performance in Harmony enrollment system.
- Assisted agents with electronic business submission, creating reports for administrators, brokers, and extracting report data for enrollment results.
- Reset application software, internet, computer, and email passwords.
- Responded to and resolved over 80 in-bound calls daily on complex claims issues.
- Communicated claims details, policy benefits and limitations, claims processes to stakeholders, clients, brokers and agents.
- Processed and paid wellness claims benefits to customers and paid medical fees to outside institutions.
Education
Bachelor of Arts -
University of South Carolina
Columbia, SCSkills
- Medicare compliance
- Policy writing
- Report creation
- Stakeholder engagement
- Contract management
- Process improvement
- Technical support
- Medicaid compliance
- Claims reconciliation
- Operations management
- Systems Specialist
Certification
- Professional Academy for Healthcare Management (PAHM), American Health Insurance Plans (AHIP), 02/08/19
- Associate Public Manager Certificate, Department of Administrative Division of State Human Resources, 03/31/17
Timeline
Adult Education and Family Literacy Act (AEFLA) Grant Reviewer “Contractor”
South Carolina Department of Education/Office of Adult Education (SCDE/OAE)
06.2021 - 07.2021
Senior Consultant
South Carolina Department of Health and Human Services (SCDHHS)
12.2014 - Current
Electronic Data Specialist
AFLAC Group Insurance
11.2012 - 12.2014
Business Analyst II
Blue Cross Blue Shield, Palmetto GBA
11.2011 - 11.2012
Enrollment Technology Analyst II
Colonial Life Insurance
11.2005 - 08.2010
Bachelor of Arts -
University of South Carolina
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