Sr. Transaction Quality Assurance Specialist
NTT Data Americas Client - Point32Health
07.2020 - 09.2024
Tonya Brown
Dorchester,MA
Summary
An experienced Quality Assurance Specialist with strong take-charge and follow-through abilities. Proven expertise in project management, benefit and payment policy administration, regulatory audits, and adherence to HIPAA guidelines.
Compliance Specialist with a successful track record in applying policy, reporting, mentorship, and training through my extensive experience in federal and state regulations.
Effective at motivating and mentoring peers while providing timely reporting and solid consultative services to leadership, fostering strong strategic relationships. Outstanding oral and written communication abilities.
Timeline
Quality Assurance and Recovery Analyst
Blue Cross Blue Shield Of Massachusetts
04.2008 - 10.2019
Benefit Systems Configuration Analyst
Blue Cross Blue Shield Of Massachusetts
10.2004 - 03.2008
Revenue Operations HIPAA Coordinator
Commonwealth of Massachusetts
01.2003 - 09.2004
Health Insurance Administration Certificate -
Aquinas College
Health And Life Insurance License -
Kaplan Career Institute
Work Availability
monday
tuesday
wednesday
thursday
friday
saturday
sunday
morning
afternoon
evening
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Quote
There is a powerful driving force inside every human being that, once unleashed, can make any vision, dream, or desire a reality.
Tony Robbins
Skills
- Benefit, Pricing, Provider Policy Administration
- Claims, Coordination of Benefit and Third-Party Administration
- GIC, Commerical and Sarbanes-Oxley auditing
- Stakeholder Management
- Quality Control Risk Assessment
- Data Analysis and Reporting
- Project Management
- Oracle Insurance Systems
- HIPAA Regulations
- Sharepoint
- Microsoft 365 and Teams
- Fundamental Access and Powerpoint
- Benefit and Pricing Configuration and Testing
Work History
Sr. Transaction Quality Assurance Specialist
NTT Data Americas Client - Point32Health
07.2020 - 09.2024
- Consulting for NTT Data handling operations to assist in the merger of Harvard Pilgrim and Tufts Health Care, now Point32Health.
- Instrumental in Senior-Level Oracle System benefit administration, enrollment verification, quality control, claims adjudication, third-party coordination of benefits, and peer review maintaining a 90-99% accuracy rate.
- Charged with the management of all plan metrics reporting.
- Leading Sharepoint Requests For Proposal updates to secure sales and renewal retention success by 95%.
- Executor of regulatory Group Insurance Commission, Commercial, DOI, and Sarbanes-Oxley audits.
Quality Assurance and Recovery Analyst
Blue Cross Blue Shield Of Massachusetts
04.2008 - 10.2019
- Charged with Benefit, Pricing, and Payment Policy quality control for over 300+ BCBS Mass plan products,
- At the helm of regulatory Group Insurance Commission, Commerical and Sarbanes-Oxley audits alongside Sales and Risk Management boosting enrollment demographics.
- Championed recovery-related tasks in coordination with third-party vendors.
- Instrumental in creating workflows and department-wide user manuals.
- Responsible for User Acceptance Testing of complex plan designs and defect triage using Quality Center HP_ALM modeling. producing a 98% accuracy rate.
- Milestone achievement developing the Testing Process Acceleration tool to streamline and increase benefit validation speed by 75%.
Benefit Systems Configuration Analyst
Blue Cross Blue Shield Of Massachusetts
10.2004 - 03.2008
- Migrated 200+ health plan products to the MetaVance Software System application to ensure 95% benefits coding accuracy
- Co-lead of the Benefit Configuration Team responsible for defining 100% of keyword-building system code values and peer mentoring
- Assigned Benefit Team representative to discuss regulatory guidelines and coordinate with multiple business areas for operational agility.
Revenue Operations HIPAA Coordinator
Commonwealth of Massachusetts
01.2003 - 09.2004
- As MassHealth Coordinator, At the helm of developing the HIPAA-compliant system for processing third-party liability claims, EDI file transactions, and CMS correspondence.
Education
Health Insurance Administration Certificate -
Aquinas College
Newton, MAHealth And Life Insurance License -
Kaplan Career Institute
Boston, MAOverview
22
22
years of professional experience
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