Tawana Brown

Tawana Brown, PMP Saint Louis, MO --in/tawana-brown Product Development & Implementation | Root Cause Analysis | Requirements Gathering Process Improvements | UAT, Smoke Testing, Quality Assurance Versatile Analyst and Project Manager with extensive experience in healthcare and insurance operations. Skilled at translating complex requirements into clear, actionable deliverables for both technical and non-technical stakeholders. Proven ability to build strong relationships, lead cross-functional teams, and present business process flows and system enhancements to leadership. Experienced in writing epics, features, and collaborating with systems analysts to support agile development lifecycles. Adept at managing backlogs, navigating uncertainty, and driving solutions independently in fast-paced, high-growth environments. Technically proficient in SQL, Power BI, Tableau, Postman, Facets, and Visio, with hands-on knowledge of EHR, claims, and benefit configuration systems. Project Lifecycle Management | Data Analysis & Reporting | Agile & Waterfall Methodologies Stakeholder Management & Communication | Healthcare Payor & Claims Education Project Management Professional (PMP), Project Management Institute (PMI), Active Certificate of Specialization, Forest Park Community College, St. Louis, MO Relevant Coursework included: Microsoft Office Applications (Word, Excel PowerPoint, Access), Advanced DOS and Information Systems Business, Database Management, Introduction to SQL, HTML, Introduction to Java, Visual Basic Programming, Programming in Basic and Oracle (Database Administrations, PL/SQL, Design and Implementation and User Interface Design Project: Designed a nonprofit data/reporting database for Webster-Rock Hill Ministries which included defining policies, procedures, and processes. Database allows for more efficient data input and report generation, enabling quick access to information for staff. Professional Experience Independent Contractor 2019 to present Independent consultant applying business analysis, operational strategy, and project management expertise to improve performance and streamline processes. Leveraged Agile methodologies and real-time data tools to optimize workflows and monitor key performance metrics. Operated in highly ambiguous environments without formal documentation or training, demonstrating initiative, self-direction, and the ability to define structure from uncertainty. Applied agile project management to optimize routing, daily workflows, & client communications, achieving 95%+ Oversaw full-cycle fulfillment execution, resolving issues in real time and maintaining service-level compliance Managed high-volume scheduling and real-time service prioritization using logistics platforms Demonstrated adaptability and analytical thinking in a fast-paced, client-facing environment Tracked performance data in Excel, including delivery KPIs, cost-per-route, & time metrics ELEVANCE HEALTHCARE, Saint Louis, MO Business Analyst III2021 to 2024 Worked within the Government Business Division, handling complex requests through the InterAct dashboard. Configured claims processing rules in Facets EHR system ensuring compliance with payer guidelines across various tables. Analyzed and resolved encounter data discrepancies, aligning with CMS and state regulations. Supported claims adjudication system enhancements by documenting business rules and performing UAT. Maintained 98% accuracy in completing requests within a 25-day timeframe Conducted data analysis achieving ROI financial targets savings of $1,200 Verified API data interactions between front-end and back-end system Tawana-Two SYLLOGISTEKS / CENTENE CORP, Saint Louis, MO Senior Business System Analyst2020 to 2023 Collaborated with Clinical Systems Operations team to process prior authorizations in line with Medicare, Medicaid, and Marketplace program guidelines, ensuring HIPAA compliance during cloud migration of clinical authorization systems. Contributed to cloud migration and app development, supporting developers in optimizing usability, performance, and data retrieval during the AWS Cloud transition. Led User Acceptance Testing (UAT) and smoke testing for EHR updates, ensuring system performance met clinical and operational requirements. Recognized for exceptional attention to detail, tasked with conducting secondary reviews for rule testing Tested REST APIs using Postman to validate authorization responses from the provider portal Mapped Medicare and Medicaid encounter data for submission to CMS/state regulators Worked with 837/835 EDI transactions to process prior authorizations per guidelines KELLY SERVICES / CIGNA-EXPRESS SCRIPTS, Saint Louis, MO Account Installation Lead Analyst2019 to 2020 Functioned as subject matter expert (SME), mentoring and training team members while overseeing client requests concerning PBM product requirements increasing productivity by 15%. Played a crucial role in ensuring timely completion of end-to-end implementations, implementing tiered pharmacy formularies benefits including deductibles, out-of-pocket limits, and cap updates on client website. Analyzed claims and pharmacy benefit data using SQL and Excel, generating insights for process optimization. Configured and maintained EHR systems, ensuring accurate benefit administration and compliance Reviewed BIDs and completed Copay Install Grid to ensure accurate configuration of benefits Partnered with IT, claims, & stakeholders to improve claims processing workflows LUMERIS, Saint Louis, MO Business System Analyst2018 to 2019 Managed Facets Business Applications for Medicare Advantage plans, performing configuration, testing, and implementation of new and/or existing products, which included financial aspects such as claim processing and data accuracy. Provided support for various claims applications, system integrations, and third-party applications. Collaborated with QA team to identify test cases and supported migration of benefit structures from development to production. Completed Agile/Scrum Boot Camp, using JIRA and Azure DevOps to manage user stories, epics, and backlogs Improved configuration time & efficiency, resulting in fewer template errors and reducing letter rejections by 80% Updated agreements, ensuring system compliance by integrating HCPCS and ICD10 code updates from CMS Created UML diagrams and flowcharts for system workflows and process improvements using Visio MAGELLAN HEALTH SERVICES, Saint Louis, MO Benefit Configuration Analyst2010 to 2017 Led benefit configuration initiatives and served as a Project Manager on claims adjudication processes, ensuring compliance with HIPAA and CMS guidelines. Managed benefit design updates, HCPCS/ICD-10 coding integration, and participated in full system lifecycle—from requirements gathering to testing and deployment. Partnered with QA, IT, and business stakeholders to ensure accurate implementation of benefit plans within legacy and production environments. Analyzed benefit plan design requirements and translated business rules into system configurations to support accurate claims adjudication Led discovery sessions with stakeholders to define system enhancements and maintain technical documentation in line with SOX standards Executed and validated UAT and configuration testing to ensure system accuracy across benefit structures Supported FirstRx adjudication setup and collaborated cross-functionally on configuration audits and updates Developed automation tools that reduced manual testing by 40%, enhancing operational efficiency Developed reports and benefit configuration summaries using Cognos (Power BI) and Excel