Quality Assurance Specialist

Tonya Brown

Boston, MA ***** • 617-***-**** • *************@*****.*** • WWW: www.linkedin.com/in/tonyabrown3284aa91

Professional Summary

Accomplished Senior Quality Assurance Specialist with extensive experience in benefit, administration, regulatory compliance, and stakeholder management. Proven ability to optimize operations, manage complex healthcare contracts, and ensure compliance with federal and state regulations. Recognized for strategic thinking, effective cross-functional collaboration, and a commitment to improving healthcare outcomes and administrative efficiency. Skilled in risk assessment, and project leadership, leveraging technical expertise and exceptional interpersonal communication to deliver exceptional results with precision and attention to detail.

Skills

Contract Compliance & Vendor Management

Benefit, Pricing, Provider, and Medical Policy Administration

Regulatory Audits (HIPAA, CMS, Sarbanes-Oxley)

Stakeholder Collaboration & Engagement

Data Analysis, Reporting, & Metrics Management

Project & Process Management

Health Plan Administration & Claims Coordination

Tools: SharePoint, JIRA, Microsoft 365 Suite, Oracle Insurance Systems, Stakeholder Engagement

Requirements analysis

Work History

Senior Quality Assurance Specialist, 07/2020 to 09/2024

NTT Data Americas Client - Point32Health – Quincy, MA

Consulted for NTT Data, a global IT company, to support the successful merger of Harvard Pilgrim and Tufts Health Care into Point32Health by managing operations and ensuring seamless integration.

Managed quality control of benefit administration and claims adjudication, ensuring a 90-99% accuracy rate across multiple products.

Provided actionable insights through comprehensive metrics reporting to enhance operational efficiency and decision-making.

Led contract compliance initiatives by managing regulatory audits, including Sarbanes-Oxley and Group Insurance Commission reviews, while directing SharePoint Request for Proposal updates to achieve a 95% improvement in sales and renewal retention, ensuring regulatory adherence and resolving client intent issues through collaboration with internal teams and external stakeholders.

Quality Assurance and Recovery Analyst, 04/2008 to 10/2019

Blue Cross Blue Shield Of Massachusetts – Hingham, MA

Ensured benefit, pricing, and payment policy compliance for over 300+ products across various plan types, maintaining 100% claims processing accuracy.

Played a key role in developing the Benefit Testing Process Acceleration Tool, which optimized validation processes, minimized errors, and improved overall efficiency. Conducted comprehensive User Acceptance Testing (UAT) for benefit coding on complex plan designs, successfully addressing client concerns and ensuring compliance.

Coordinated with third-party vendors on recovery tasks and vendor file exchanges, enhancing claims processing workflows.

Created training manuals and workflow material to support departmental development and operational consistency. Ensured benefit, pricing, and payment policy compliance for over 300+ products across various plan types, maintaining 100% claims processing accuracy

Played a key role in developing the Benefit Testing Process Acceleration Tool, which optimized validation processes, minimized errors, and improved overall efficiency

Conducted comprehensive User Acceptance Testing (UAT) for benefit coding on complex plan designs, successfully addressing client concerns and ensuring compliance

Coordinated with third-party vendors on recovery tasks and vendor file exchanges, enhancing claims processing workflows

Created training manuals and workflow material to support departmental development and operational consistency

Benefit Systems Configuration Analyst, 10/2004 to 03/2008

Blue Cross Blue Shield Of Massachusetts – Hingham, MA

Participated in developing new system software, migrating over 200 health plan products.

Co-led the Benefit Keyword Configuration Team, defining system code values and driving cross-functional implementation strategies.

Collaborated across business areas as Benefits Liaison to enhance operational agility and streamline workflows.

Revenue Operations HIPAA Coordinator

Commonwealth of Massachusetts – Chelsea, MA

As a Mass Health Coordinator, charged with developing the Massachusetts HIPAA-compliant information system related to coordinating third-party liability claims processing, EDI file transactions, and CMS correspondence methodology, which resulted in successful implementation.

Education

Certificate: Health Care Administration

Aquinas College - Newton, MA

Health And Life Insurance Licensure, Expected in 01/2025

Kaplan Career Institute - Currently Enrolled - Boston, MA

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