Tammy Brown is a healthcare insurance professional seeking a position utilizing her extensive experience in healthcare operations. She has over 20 years of experience in roles involving claims processing, benefits configuration, provider data analysis, and quality assurance. Her resume outlines credentials and skills in areas such as medical coding, Six Sigma certification, and proficiency with various healthcare software programs and data systems.

1. T a m m y B r o w n
7830 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, MD
Yellow Belt Certified June 2011
Drexel University Philadelphia, PA
Physician 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 n

2. Page 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, denials, 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 action may be
initiated.
• Determine root cause, and source of errors, which will be the stepping stone for developing 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.

3. T a m m y B r o w n
Page 3
Jacobson Group Chicago, IL
Perot Systems Inc. Dallas, TX
Travel 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 schedules, 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 configuration set-up and maintenance, Analysis, documentation, data entry,
configuration 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