Quality Control Project Management
Resume:
Tonya Burns
La Vergne, Tennessee 37086
************@*****.***
SUMMARY:
Experienced Business Professional with diversified Healthcare or industry exposure, a proven
track record for meeting quality and productivity metrics and demonstrated success in:
Quality Control
Office Management
Claims Analysis
Cross Functional Collaboration
Customer Satisfaction & Retention
Project Management
Management
PROFESSIONAL EXPERIENCE:
Access Dental Lab, Antioch, Tennessee
Lab Production Specialist 2018 - present
Arch Prep Specialist
1.Work with 3D printed arches to create custom invisible aligners
Multi-task between light machinery in an assembly work environment requiring high attention to detail
Maintain organized processes to keep identified arches staged together
Review final work and check that all quality standards have been met before passing the work to the next technician for completion
Perform manual adjustments throughout the aligner production process using polishers, scissors, and other hand tools
Responsible for creating labels and putting aligners into bags free of any debris
Prepare items for shipment using ProShip software
Maintain the work area and equipment in a clean and orderly condition and follow prescribed safety regulations
Complete each aligner user checklist as the aligners are manufactured throughout the assembly line
Loading and staging raw materials and finished product
2.Work as part of a team with emphasis on communication
Prepare arches in an organized manner
Follow all established W.I. and S.O.P.s for arch prep
Maintain a clean and professional work environment
Ensure you stay on task, and meet established hourly production targets
Audit processes and housekeeping to ensure consistency at all times
Never pass a defect knowingly to the next operation
Facilitate problem solving within your team
Relieve other Team Members in their absence, filling in when necessary
Parallon, Brentwood, Tennessee
Product Analyst 2016-present
EDI Pre-Billing Specialist
2015-2016
1.Analyzes current or potential business processes and reviews existing information systems.
Interviews users.
Analyzes process flows.
Maps/flowcharts existing business processes.
Identifies opportunities for improvement.
Maps/flowcharts improvements to existing business processes.
Documents existing business processes and business rules.
Designs & implements reports to improve business processes & workflow.
Designs & implements screen layouts to improve business processes & workflow.
2.Develops testing.
Coordinates and executes testing activities with clients.
Assists Testing and QA services, as a product SME in the development of Master and Detailed test plans and executes those plans in various product support environments.
Provides process and methodology oversight to ensure product release meets quality standards.
3.Develops Business Requirements to assist Reporting Group in report development
Identifies reporting requirements and specs out report format, content, calculations, data elements & sources of information based on product knowledge.
Assists in Identifying data, interfaces, and test requirements.
4.Develops organizational changes and implementation plans.
Analyzes training and organizational changes.
Designs training material.
Trains users in new procedures and systems.
5.Resolves system issues and problems.
6.Responsible for the product vision and product roadmap.
Works closely with all functions to develop comprehensive product specifications that will serve as a key communications vehicle for the product director.
Owns the product roadmap and delivery schedule.
Leads cross-functioning teams through the steps of developing new solutions, prioritizing features, negotiating tradeoffs, and guiding the product from concept through implementation.
Gathers broad input, researches and evaluates technology trends.
Manages the product from concept through fruition with little guidance.
7.Provides post implementation support.
Conducts post implementation review and documents goal attainment.
Communicates project status and objectives.
Communicates with project team, clients and vendors.
Develops and leads communications as part of system implementation efforts.
8.Works independently with internal clients to identify opportunities for improvement.
9.Problem Resolution.
Identifies problems
Resolves problems
Implements plans for improvement within established time frames.
10.Prepares documentation.
Documentation may include narratives, charts, graphs, matrices; diagrams, flowcharts, and data element relationship attribute analysis.
Presents quantitative and qualitative information based on the above, in a clear and concise manner.
Structures documentation into knowledge bases that can be used for reference, problem solving, planning and development.
Develops clear and thoughtful presentations for groups of all sizes and levels.
Documentation effectively communicates business and related systems processes.
Practices problem avoidance and root cause analysis.
11.Identifies trends and recommends improvements accordingly.
12.Reviews specifications and makes recommendations for changes and approval.
13.Practices Business Owner Concept.
14.May perform other duties as assigned.
15.Practices and adheres to the “Code of Conduct” philosophy and “Missions and Values Statement”.
EDI Pre-Billing Specialist
Review and prepare claims for electronic billing submission.
Review and prepare claims for manual submission.
Correct billing error according to process and resubmit claim to insurance carrier.
Print and mail HCFA 1500 as necessary for account resolution.
Review insurance EOB/Payer forms for manual billing according to payer requirements.
Reports to EDI Manager or Director of EDI/Billing when a payer should be set up to bill electronically.
Maintains work operations by following policies and procedures.
Enhances billing department reputation by accepting ownership for accomplishing new and different requests; exploring opportunities to add value to job accomplishments.
Responsible for working reconciliation reports according to process.
Ensure compliance with HIPPA requirements
Ensures all claims are processed and confirmed electronically.
Meet and maintain established departmental performance metrics for production and quality.
Practice and adhere to the “Code of Conduct” philosophy and “Mission and Value Statement”
Research and fix electronic claims with payer adjudication errors.
Other duties as assigned.
MedSolutions, Franklin, Tennessee
Claims Supervisor 2011-2014
Strong organizational abilities to manage large amounts of data and paperwork involved and to make sure that each document is filed properly or passed on to the next step in the claims processing chain.
Excellent customer service skills and organizational skills
Professional aptitude to solve problems and answer questions based on current information
Excellent communication and interpersonal skills with internal and external clients.
Work very closely with senior management in planning and resolving escalated or non escalated issues.
Ability to multi-task, communicate, and educate staff in a highly professional and effective manner
Research and manage complex issues to resolution
Hire and manage the performance of customer service and claims processing analyst
Responsible for quarterly bonuses
Work directly with our clearing house involving data that was mapped/submitted incorrectly via paper or electronic filing.
Work with other insurance company executives and staff in order to meet performance goals and other quality standards.
Run production reports daily for senior management.
WEBMD/Emdeon 2004-2010
Senior Enrollment Project Manager 2009-2010
Research Specialist II 2007-2009
Claims Analyst 2004-2007
Successfully project managed multiple electronic billing conversions (over 70 client accounts, Partnered with customer, developed project plans, enrolled insurance carriers, delivered system training- for processing medical, hospital and dental claims) achieving a track record for on-time “go live dates” with high customer satisfaction levels, productivity and minimal rejected claims.
Delivered system training resulting in higher claims processing accuracy and productivity.
Responded to escalated cases from the customer's complaints
Reviewed and researched rejected Emdeon claims in order to expedite resolution and maintain high customer satisfaction and retention.
Collaborated with Insurance companies and vendors as well as cross functionally to resolve complex, escalated claims problems.
Created log ins and passwords for clients to submit their claims and to utilize Emdeon systems.
Assisted clients with filling out paper work in order to ensure accurate and timely enrollment.
Reviewed and researched rejected claims involving software issues in order to formulate recommendations for the clients that expedited resolution and maintained high customer satisfaction and retention.
Responded to customer inquires (phone calls, email and written correspondence) resulting in better access, claims processing and customer satisfaction.
CENDANT TRAVEL, Nashville, Tennessee 2003-2004
Quality Control Agent
Monitored on and off-line travel records ensuring high accuracy and customer satisfaction.
Partnered with clients to effectively assess needs/preferences, achieving a track record for high customer satisfaction and retention.
UNIQUE WORLDWIDE SERVICES, Nashville, Tennessee 2002- 2003
Office Manager
Led and developed a Sales Team that consistently met/exceeded Fire Safety product sales goals.
Managed overall office operations (interviewed and hired staff, trained staff, performed accounting, scheduled off-site meetings) achieving a track record for uninterrupted productivity and a well trained, highly productive sales team.
VANDERBILT HOSPITAL, Nashville, Tennessee 1995- 2002
Certified Nurse's Technician & Medical Receptionist
MCFARLAND HOSPITAL, Lebanon, Tennessee 1994- 1995
Certified Nurse Technician
EDUCATION:
BS, Business Management & MIS (Management Information Systems)-St. Thomas Aquinas University, Nashville, Tennessee
Master of Healthcare Administration (M.H.A) - currently pursuing
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