Tonya Roe Email & Phone Number

Bloomfield, Ct, Us

- Managed team of 120 employees and contractors with a budget of $22M responsible for development of integrations and solutions for administrative functions, as well as business configuration and infrastructure support for QNXT and EzCap applications. - Partnered with Shared Operations business leader to ensure IT systems support timely claims payment, enrollment and premium billing for an approximately 500k member Medicare Advantage health plan, offering multiple flavors of MA, including HMO, DSNP, ISNP, PPO and POS - Dramatically enhanced CMS compliance with claims and enrollment related processes and metric through a combination of vendor solutions and custom development. - Improved management of configuration process resulting in significant improvements in quality during the Annual Enrollment Period, and permanent reduction of inventory backlogs- Initiated offshore staffing initiative to increase delivery capacity at reduced cost- Selected for Cigna’s prestigious IT Leadership Program (ITLP) – a multi-year internal development program for preparing the next generation of IT leadership- Improved system performance and introduced automated processes to facilitate high growth targets in the business

Oakland, California, Us

I directed the Application Build team for Kaiser Permanente's Epic Tapestry AP install. The team of 22 direct reports and 18 matrixed employees delivered system configuration for national functions as well as 7 Kaiser Permanente regions. We work closely with our partners in IT and business to provide a system that supports the short and long term business objectives.Key Achievements:- Brought together a team of people from different backgrounds, experience levels and organizations to very quickly learn a new application - Partnered with Business Operations to deliver core configuration that met the needs of national claims as well as individual regions - Completed Hawaii deliverables on time, including a Workflow Walkthrough in Hawaii that demonstrated the capabilities of the new system to senior executives - Grew my team of implementation leads and empowered them to take full responsibility for their regions, while still ensuring standardization and sharing of best practices across implementations. - Hired 12 new team members, including 5 associates through the StartIT program - Developed deeper relationships with partner IT organizations to develop support models that meet business needed - Taken on added responsibility for support of Provider Systems Administration

Oakland, California, Us

Lead Business Consultant on the team assuming responsibility for the Xcelys product at Kaiser Permanente. Key Acheivements: - Trainied new team members on health plan, claims administration and Xcelys product - Consulted on Xcelys and Diamond enhacement designs

Oakland, California, Us

Roles/Activities: - Supported the configuration activities of the MON implementation - Worked with stakeholders in all regions to ensure all 5 Xcelys regions and CA have configuration that meets the diverse set of business needs while still driving toward consistency and maintainability- Led Hawaii configuration team, including - Planning and directing configuration activities for the Hawaii region - Lead a team of as many as 11 employees and contractors, all working remotely, to complete a large volume of work in a short timeframe - Partnered with UAT and the HI regional SMEs to ensure a quality product was deliveredSkills/Tools: - Leadership/Influence - Hawaii Claims Regulations - Xcelys/ClaimsConnect Platform - Project Management and Estimating

Oakland, California, Us

Manager, Claims Performance Improvement July 2005 - April 2011Roles/Activities: -Developed Business Analysis team, currently 16 members strong, responsible for end to end support of the NW Diamond Claims system including:--Configuration of authorizations, benefits and non-contracted providers--Working with NCSS for provider, finance and general configuration--Identifying system enhancement needs, developing business requirements, partnering with IT on solution design and testing final product--Managing interfaces to all upstream and downstream systems--Maximizing auto-adjudication and quality of claims payment--Increasing EDI through partnering with NEBO, provider contracting and other regions to bring on new providers and trading partners-Participated in Single Instance Xcelys configuration sessions and helped design the national configuration standards established by the team.-Project managed the exchange of encounters between HealthConnect and Diamond for Medicare Advantage, Deductible, Supplemental and WA HMO lines of business-Managed the systems side of the transition from the challenging start to the Diamond platform to 2 years of green metrics in Claims Administration-Managed a variety of functions including COB Investigations, Recoveries and Training and Documentation-Built strong relationships in NW MSSA, Revenue Cycle and PFS, as well as Program Office, IT and other Kaiser regionsSkills/Tools: -Leadership/Influence-Managed Care and Indemnity Insurance -Medicare and Commercial Claims Regulations-Lean Six Sigma green belt training -Diamond Platform-Project Management

Worldwide, Oo

Integrated Delivery System June 2004 - July 2005Roles/Activities: -Managed team of up to 20 clients and consultants in multiple locations responsible for testing of the Diamond managed care system, including business system testing, procedure testing and user acceptance testing-Established testing methodology, automated tools and metrics to review claims payment accuracy -Diagnosed problems and recommended solutions for configuration problems, working with business users from provider contracting, benefits and claims as well as configuration staffSkills/Tools: -Project Management -Claims, Auths, Benefits and Provider Pricing -Diamond Managed Care System -Managed Care and Indemnity InsuranceIntegrated Delivery System July 2003 - February 2004Roles/Activities: -Managed the design and build of 30 HL7 and ANSI X12 interfaces between Epic and clinical ancillaries, financial systems, and external trading partners-Facilitated detailed design sessions bringing together business users, local IT and national IT to refine business requirements and design specs-Acted as a liaison between Northwest region and national IT to communicate and resolve issuesSkills/Tools: -Project Management HL7 Interfaces -Epic Suite of Tools -Healthcare Providers and HospitalsHealth Insurance Company June 2002 - June 2003Roles/Activities: -Managed team of up to 25 responsible for Model Office testing of Facets managed care system, focusing on testing processes and system components for sales, membership, provider, benefits and claims-Established testing methodology, tools and metrics to test more efficiently and provide improved management reporting-Worked closely with business area executives and project leadership to ensure full coverage and to determine success criteria for the completion of testing Skills/Tools: -Project Management -Claims, Benefits and Provider Pricing -Facets Managed Care System -Managed Care and Indemnity Insurance

Dublin 2, Ie

Various roles of increasing responsibility. Key accomplishments:-Planned and managed core system software selection efforts, including creating approach and accelerated workplan -Helped define overall programs, including budget, resources and project plan, to implement new core systems-Led teams of 5-25 client and consulting personnel responsible for configuration, testing and business process design for managed care system implementations-Responsible for project management activities and up to $1 million budget -Worked with executive sponsors and project leadership to identify and resolve issues and risks-Identified technical architecture components required for a packaged system implementation and provided technical architecture framework customized for packaged system. Skills/Tools: -Budgeting, Planning and Estimating -Facets Managed Care System-Diamond Managed Care System -Project Management -Managed Care and Indemnity Insurance-Testing