Rena Brown Email & Phone Number

Kansas City, Missouri, United States

Provided management and support of contracts team with full oversight of on and off exchange applications and project implementation with emphasis on federal and state specific ACA compliance. Interpreted federal and state contract requirements, requested necessary waivers and approvals and documented contract compliance. Participated in the formulation, development, and revision of policies, procedures, and templates. Advised staff on contract management and maintained audit files. • Regulatory oversight for all Affordable Care Act (ACA) applications and submission activities for individual and small group Qualified Health Plan and Stand-Alone Dental Plans for 14 states, including weekly meetings. • Set strategic direction for project management and maintained oversight of all state and federal deadlines.• Worked in tandem with government affairs and all interested functional groups across the organization to influence stakeholders to support key projects/programs to ensure positive outcomes and deliver results.• Solution driven working directly with CMS and the NAIC to help identify efficiencies in system programming and capacity.• Analyze and make recommendations for efficiencies in developing the ACA applications and submissions.• Served as a subject matter expert for ACA requirements and acted as a liaison between state and federal regulators and Anthem functional groups. • Recognized as the SERFF issuer representative for the NAIC Board in 2019-2020

Overland Park, Kansas, United States

Developed and maintained effective and efficient processes for determining the appropriate admission status based on the regulatory and reimbursement requirements. Identified and analyzed appropriate metrics, evaluated the data, and designed and implemented process improvement projects. Utilized internal electronic based record workflow systems and quickly determined the legal right to release records based on HIPAA rules and regulations. • Led two clinical supervisors and 50 associates to confirm eligibility, process initial requests and process additional requests for home health care. • Ensured compliance with performance standards by monitoring turnaround time and telephone statistics.

Kansas City, Kansas, United States

Designed and implemented various policies and procedures for claims. Provided services to all business requirements and ensured optimal handling of all claims and investigated all issues. Evaluated all new claims and administered all data integrity data. Monitored effectiveness of all programs and provided support to all open claim file reviews and managed all payment cycle to ensure compliance to all contract requirements. Analyzed all claims to ensure optimal quality and prepared reports for various business units and monitored all chargeback expenses and provided report to all clients and management. • Managed 40+ employees and served as the lead in the development of the new business administration system (Vitech – V3). • Developed positive relationships with outside service partners, including CIGNA and CIGNA Behavioral Health

Overland Park, Kansas, United States

Claims Manager, Medical Review Division, 2007 – 2009 Monitored billing activities, performance management, and production standards and quality of results. Provided technical assistance to clinical staff in order to initiate billing to all appropriate payer types. Analyzed data for bill presentation based on requirements and reviewed claims for quality. Worked to prepare or supervise the preparation of processes and bill presentation to ensure quality and accuracy. Remained up to date on regulations and implemented changes regarding claims and billing requirements as necessary to comply with regulations. • Improved relationships with outside vendors in the areas of utilization and case management, transplants, and subrogation. Senior Project Manager, 2006 – 2007 Coordinated internal resources and vendors for the flowless execution of projects. Ensured that all projects were delivered on-time, within scope, and within budget. Developed project scopes and objectives, involving all relevant stakeholder and ensuring technical feasibility. Ensure resource availability and allocation and developed a detailed project plan to track progress. Measured project performance using appropriate systems, tools, and techniques. • Led a successful implementation of a correspondence project, involving collection, review, revision, and team approval of approximately 150 online forms and letters.

Kansas City, Missouri, United States

Reviewed contacts to prevent potential disputes and financial risks. Analyzed contract clauses, stipulations, obligations, and liabilities. Recommended and drafted contract provisions and amendments. Negotiated contract terms, payment structures, and reimbursement. Researched industry compliance regulations and policies. Evaluated internal operational and procedural compliance. Analyzed and updated existing compliance policies and related documentation. Collaborated with CMS on HIPAA audits.

Seeking Certificate, Regulatory Compliance Specialization

Bachelor Of Science - Bs, Journalism

Activities and Societies: Writer and photojournalist for the Lincoln Clarion Afternoon and weekend DJ for KLUM Radio