T a m m y B r o w n7830 Waterwheel Way, Jonesboro, GA 30238

(240) 480-0841 (cell) Tammy72b@gmail.com

A Healthcare Insurance Business Professional, with a myriad of experience and knowledge of several processing platforms, and systems. A dedicated hard working, reliable, professional committed to strong work ethics, seeks a challenging position utilizing all my extensive analytical background and vast knowledge in healthcare operations.

E D U C A T I O N

Six Sigma Columbia, MDYellow Belt Certified June 2011

Drexel University Philadelphia, PAPhysician Based Medical Coding Certificate 2005

PSI Institute of Washington Silver Spring, MD Data Information Specialist 1993-1994

SKILLS

Extensive knowledge of all aspects of Claims, Billing, Auditing, Adjustments, Credentialing, Plan Building, and Provider and Benefits Configuration. Possess strong interpersonal and communication skills. Specialize in quality customer care, along with excellent analytical, leadership, and problem solving ability. I possess a strong work ethic, as well as efficient researching skills. Excellent in Microsoft Word, Excel, Outlook, PowerPoint, Access, Salesforce and SharePoint. Certified in Medical Terminology. Knowledge of CPT-4, ICD-9, ICD-10, ASA, HCPCS codes, ASC pricing, Inpatient Outpatient Hospital, Mental Health, ER, Surgery, Dental, COB, TPA, CAQH, NPI, Sales Force, Amisys, AS400, Oracle, SharePoint, and Facets. Proficient in several of the major medical payment and processing systems.

P R O F E S S I O N A L E X P E R I E N C E

Highpoint Solutions King of Prussia, PA Claims/Configuration Analyst 01/2016 to Present

Duties include; Performs Benefit Configuration Activities according to the Groups Evidence of Coverage (EOC). Ensures the provider, authorization and benefits configuration meets established business rules and procedures.

Analyzes benefit explanation of coverage to determine best approach for loading benefits plan offered including co-pays, out-of-pocket maximums and state/regulatory benefits.

Researches and completes root cause analysis of customer service intakes and claim errors.

Creating and Testing case scenarios using the Deductible/OOP Matrix and Medical Definition Determinants.

Minimizes system errors and pended claims through effective research, analysis, solution development, configuration, testing, communications and documentation of reactive and proactive corrective actions. Proactively conducts audits to confirm accuracy of set up and data loads.

Processed Groups in by coding, building, and configuring products for new business & renewals.

T a m m y B r o w nPage 2

HealthTech Resources Inc. Phoenix, AZ Configuration Analyst/ UAT Tester 01/2014 to 1/2016

Building new benefit packages for Custom Plans, Individual, Family, Small Group, Large Groups, and HSA Benefit Packages.

Configuring Benefit Packages, using Benefit Summaries and Plan Documents. Reviewing existing Benefit Packages to make sure all the accumulators, pends, de-

nials, copays, coinsurance, deductibles, limitations, and out of pockets are set up correctly.

Develops, documents, and executes builds for products for use in testing and production including, but not limited to trouble tickets, software releases and fixes, enhancements and new product development.

Minimizes system errors and pended claims through effective research, analysis, solution development, configuration, testing, communications and documentation of reactive and proactive corrective actions. Proactively conducts audits to confirm accuracy of set up and data loads.

Researches and completes root cause analysis of customer service intakes and claim errors.

Utilized experience with benefit configuration for Medical Plan Applications, such as product, supplemental tables, service payments, service rule definition, limits, deductibles, processing control agent and medical utilization edits by procedure code/service.

Design, build and test configuration in support of business requirements ... Processed Groups in by coding, building, and configuring products for new business

& renewals.

United Healthcare Care (Vision) Columbia, MD Lead Provider Data Analyst/QA Analyst 11/09 to 01/2014

Resolved questions and issues from provider group contracts regarding Demographic and Fee Schedules.

Responsible for anticipating and resolving quality, claims, and contract issues for providers

Handled Providers Data Technical assistance and guidance on quality improvement measures

Analyzes data and reports to track trends and improve current processes Performs internal Quality Control reviews on processes and activities while recommending

improvement Lead for implementing appropriate risk assessment process designed to identify and

correct deficiencies. Build and maintain positive business relationships within internal departments,

also maintained high quality work and productivity expectations. Distributed work daily to team from queues and spreadsheets, handled and resolved

escalated issues Provide explanations and information back to others on difficult issues Lead project from intake to implementation for mass provider contracting projects Participate in process improvement and system enhancement definition and testing Create and initiate policy specific audits; Extract audit outcome and findings Review work performed by others Present findings to Internal Partners and gain understanding, so that corrective ac-

tion may be initiated. Determine root cause, and source of errors, which will be the stepping stone for de-

veloping the course of action. Work with management to define issues and potential enhancements which would

improve the audit experience. Assists with the coordination of external audits and reviews Perform manual testing for multiple applications with complex interfaces on various

platforms

Work with business users, designers and programmers to create required project documents.

Review and compare all Sources of Truth documents for consistency, compliance, and customer intent.

Prioritize and organize work flow and assign duties as needed in order to meet deadlines.

T a m m y B r o w nPage 3

Jacobson Group Chicago, IL Perot Systems Inc. Dallas, TXTravel Staff Consultant 2001 to 2009

Held various positions such as Plan document loading; Provider Configuration specialist where I loaded and maintain providers in the system; Provider Inquiry, and Provider Maintenance, which included calling providers, loading fee sched-ules, ensuring accurate billing contracts, affiliations, and credentialing of providers, which entailed verifying addresses, names and numbers. Manually applied provider contract configuration logic to accurately price claims, Provider reimbursement con-figuration set-up and maintenance, Analysis, documentation, data entry, configura-tion and Testing of the configuration set-up to support current operational needs while Utilizing software such as Facets, Word, Excel, Access and Visio.

Membership Inquiry where I would update member information, such as benefit changes, spousal and children information; Claims Adjuster for Blue Cross and Blue Shield at multiple sites, where I research member and provider inquiries pertaining to overpayments.

Claims Examiner/Analyst for various healthcare companies, where I processed and adjudicated members claims in accordance with contract, Health plan and department guidelines

Participated in two-way communication meetings, team building and ongoing training. Provided accurate information in a timely manner with limited supervision; Responsible for providing quality customer care in a professional, and courtesy matter while projecting a positive cooperate image.

United Healthcare Care (Dental) Rockville, MD Provider Relations Rep/Credentialing 03/07 to 02/08

Key responsibilities include but are not limited to, performing claims investigations, making courtesy phone calls to providers with any issues they may have, researching and reimbursement of corrected claims, credentialing and re-credentialing.

Maintain all files and documentations, of new and existing providers. Created and submitted all unpaid or incorrect claims status projects.

Maintain provider enrollment database by set up of provider accounts & termination of provider accounts;

Loading, reviewing and interpreting provider contracts and fee schedules; Provides oversight on inquiries and claims issues and follows up with providers to

ensure problems have been resolved. Respond to calls from Providers regarding Claim Payments, Benefits and Eligibility; Assist Provider Reps and Physicians with contract issues, coverage benefits, resolve

negative balance issues, adjust incorrect claims, and Contact providers concerning missing credentialing application information.

Healthcare Financial Rockville, MD Billing Specialist 2000 - 2001

Worked for such companies as Prince Georges Hospital, Inova, IBC, and Dr. Foreman and Friedman (plastic surgeons), as their Primary Billing/Collections Specialist responsibilities include calling insurance companies, and TPA’s to check claims status, researching unpaid claims to determine action required, processing

statements to clients and patients for co-pay and other charges. Processing account payments, adjustments, write-offs, and refunds for overpayment

on accounts, providing timely follow-up on unpaid statement and claims; created and maintained all report spreadsheets for all documentation of payments received; as well as written off reports.

Verified eligibility with insurance companies; request and processed patients accounts, correcting billing errors, filing appeals, remaining current on all Medicare rules and regulations.

R e f e r e n c e s a v a i l a b l e u p o n r e q u e s t