Tonya Brown
Boston,MA
There is a powerful driving force inside every human being that, once unleashed, can make any vision, dream, or desire a reality.
Tony Robbins
Summary
Accomplished Sr. Transaction Quality Assurance Specialist with a proven track record enhancing operational efficiency and accuracy. Expert in benefit, Pricing and Medical Policy administration and regulatory auditing, demonstrated by leading successful Sharepoint updates and achieving a 95% renewal retention rate. Skilled in stakeholder management and risk assessment, showcasing a unique blend of technical and interpersonal abilities.
Effective motivational skills with peers, providers, and insurers managing strategic relationships through solid consultative services with outstanding oral and written communication.
Timeline
Sr. Transaction Quality Assurance Specialist - NTT Data Americas Client - Point32Health
2020.07 - Current
Quality Assurance and Recovery Analyst - Blue Cross Blue Shield Of Massachusetts
2008.04 - 2019.10
Benefit Systems Configuration Analyst - Blue Cross Blue Shield Of Massachusetts
2004.10 - 2008.03
Revenue Operations HIPAA Coordinator - Commonwealth of Massachusetts
- 2004.10
Aquinas College - Certificate in Health Care Administration,
Kaplan Career Institute - Boston - Health And Life Insurance License, Currently Enrolled
Work Availability
monday
tuesday
wednesday
thursday
friday
saturday
sunday
morning
afternoon
evening
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Skills
- Benefit, Payment Policy and Third-Party Administration
- Risk Assessment - System and Sales
- Stakeholder Management
- Requests for Proposal
- Extensive Implementation and Regulatory Auditing
- Group Insurance Commission
- Data Analysis and Reporting
- HIPAA Regulations
- Sharepoint / Jira
- Microsoft 365 and Teams
- User Acceptance Iteration / Regression Testing and Test Plan Development
- Oracle Insurance Systems
Work History
Sr. Transaction Quality Assurance Specialist
NTT Data Americas Client - Point32Health
2020.07 - Current
- Consulting for NTT Data Global IT company currently handling operations to assist in the merger of Harvard Pilgrim and Tufts Health Care, now Point32Health.
- Responsible for completing senior-level benefit administration, quality control, claims adjudication, third-party coordination of benefits, and peer review maintaining a 90-99% accuracy rate.
- Charged with management of all plan metrics reporting.
- Leading Sharepoint Requests For Proposal updates to secure sales and renewal retention success by 95%.
- Executor of employer group, Group Insurance Commission and Sarbanes-Oxley audits.
Quality Assurance and Recovery Analyst
Blue Cross Blue Shield Of Massachusetts
2008.04 - 2019.10
- Charged with quality control of system coding for Benefits, Pricing, and Payment Policy Administration. Sustained over 300+ Mass benefit products such as HMO, PPO, EPO, POS, Indemnity, and Cobra to ensure 100% Benefact software claim processing accuracy.
- Milestone configuration achievement made by developing a Benefit Testing Process Acceleration tool which streamlined validation of benefit coding accuracy.
- Responsible for End-to-End User Acceptance Testing of benefit coding on complex plan designs and cross-reference system functionality. Maintained functional and regression test plan development, runs, defect triage, and risk assessment using HP_ALM Linear Modeling.
- Collaborated with Sales and Audit Risk Management in group implementation audits addressing potential client intent issues for all regulatory SOC, DOI, MAR, and SSAE audits.
- Charged with supporting recovery-related tasks in coordination with third-party vendors, importing vendor file exchanges, and defining benefit claim recovery parameters.
- Instrumental in creating user manuals with instructional materials for departmental training and continuous reference.
Benefit Systems Configuration Analyst
Blue Cross Blue Shield Of Massachusetts
2004.10 - 2008.03
- Responsible for MetaVance software configuration projects focusing on migration of over 200 health plan products to ensure benefit coding accuracy.
- Co-lead of the Benefit Configuration Team keyword definition and build of system code values.
- Benefit Team workgroup representative to discuss strategy and cross-walk implementation impact.
- Coordinator of Benefits liaison, collaborating with multiple business areas to develop operational agility.
Revenue Operations HIPAA Coordinator
Commonwealth of Massachusetts
- 2004.10
- As Mass Health Coordinator, charged with development of Massachusetts HIPAA-compliant information systems related to coordination of third-party liability claims processing, EDI file transactions, and CMS correspondence methodology which resulted in successful implementation.
Education
Certificate in Health Care Administration -
Health And Life Insurance License - Currently Enrolled
Overview
20
20
years of professional experience
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