Experience

Anthem

• United States
• Insurance
• 700 & Above Employee

• Business Development Manager

  • Oct 2017 - Present

  Represents the interests of the Group Retiree Solutions (GRS) business in large scale complex projects by providing input into and review/approve business and technical requirements, tracking the project status, drive issue resolution, ensure any cross-functional impact is vetted and addressed. - Participate with Medicare Product Launch (MPL) projects relating the Sales, Consumer Portal, Product and Marketing work streams. - Assist with system migration business requirements relating to the GRS business relating the Sales, Consumer Portal, Product and Marketing work streams.

• Business Development Consultant

  • May 2013 - Present

  Conduct quality review for custom Medicare Advantage and Medicare Part D documents for the Employer Group Retiree (EGR) business segment of Medicare Programs Ensure compliance with Medicare regulations with benefit materials to members and accurate coding instructions to benefit coding teams. - Maintain complete and accurate documentation to support the review and approval process of the custom benefit charts and Benefit Mapping Grids (BMG). - Develop custom benefit plan comparisons, timely completion to documents relating to Request for Proposal (RFP) and act as a subject matter expert for the Sales Account Executives.- Development of policies and procedures, tracking grids, checklists and SharePoint sites according to compliance requirements.- Conduct training to business partners as process improvements or new documentation is developed.

• Regulatory Oversight Consultant

  • Jan 2012 - May 2013

  Provided reporting and oversight of Medicare advantage guidance. Communicated regulations with all impacted business owners to implement. Provided enterprise reporting on implementation status and compliance concerns. Responsible for testing and providing solutions for tracking tool. Provided training on tracking tool. Responsible for ensuring all policies and procedures are updated as business rules changes or regulatory changes.- Enhanced reporting from tracking system and improved business owner engagement with the tool.- Created job aids and desk level procedures to enhance user ability in tracking tool.- Developed monitoring dashboard relating to regulation changes and implementation of the changes.- Reviewed Privacy related incidents for closure and member notification impact for Resolution Health Inc. (a sister company with WellPoint) including significantly reducing the backlog of incidents within a one month period.

• Clinical Compliance Consultant Sr.

  • Mar 2010 - Jan 2012

  Participated in Quality Management (QM) activities by coordinating activities related to compliance for assigned functions. Monitored adherence to Medicare contract plans. Participated in audits, identified training/communication needs and implemented related programs to address needs. Provided regulatory guidance on other key areas.- Implemented standardization of procedures and documentation within the business area. Ensured that all policies and procedures were updated as legislation or accreditation standards changed. - Developed communications and tracked and coordinated material approvals through the Medicare compliance team.



Anthem, Inc.

• United States
• Hospitals and Health Care
• 700 & Above Employee

• Sr. Internal Auditor

  • Dec 2005 - Dec 2009

  www.trustsolutionsllc.comwww.wellpoint.com(promoted from Auditor to Senior)Evaluated compliance with and adherence to internal controls, ISO quality standards and Medicare government contract requirements through quarterly internal audits. Maintained company policies, process workflows and procedures in support of ISO standard and Medicare government regulations. - Maintained ISO 9001 certification through quality audits, training, and development of processes & procedures.- Developed company-wide Balanced Scorecard and Performance Monitoring process to measure quality and timeliness standards according to contract requirements.

• Medicare Contract & Compliance Specialist

  • Apr 2003 - Dec 2005

  www.ngsmedicare.comwww.wellpoint.com(promoted from Coordinator to Specialist)Ensured the directives received from the Centers for Medicare & Medicaid Services (CMS) were distributed and tracked to completion by all departments. - Maintained ISO 9001 certification through development of processes and procedures

• Medicare Customer Service Representative

  • Dec 2002 - Apr 2003

  www.ngsmedicare.comwww.wellpoint.comAssisted beneficiaries with inquiries and complaints about Medicare coverage, claim status and payments.- Responded to and documented telephone and written inquires timely and accurately

• Customer Service Representative

  • Feb 2002 - Dec 2002

  www.anthem.comwww.wellpoint.comResponded to benefit and claim inquiries and complaints relating to providers, agency reps, groups and subscribers. - Reviewed benefit coverage, claim payments and membership status through direct person-to-person contact, telephone and written correspondence. - Reviewed and calculated claim payments.



Lad Lake

• United States
• Non-profit Organizations
• 100 - 200 Employee

• Case Manager

  • Aug 2000 - Dec 2001

  www.ladlake.orgEducated youth with independent living and budgeting skills through formal curriculum, assisted placement in apartments, and aided with personal finances. - Case management, proper documentation, time management, court appearances, and daily contacts both in-person and via telephone. www.ladlake.orgEducated youth with independent living and budgeting skills through formal curriculum, assisted placement in apartments, and aided with personal finances. - Case management, proper documentation, time management, court appearances, and daily contacts both in-person and via telephone.



State Central Credit Union

• Senior Member Services Consultant

  • Jan 1998 - Dec 2001

  www.statecentral.com(promoted from Teller to Representative to Consultant)Maintained members’ accounts, loan processing and branch balancing- Opened/closed and maintained members’ accounts, Loan Processing, Branch Balancing including security clearance, Cash Verification, Cash Handling, Sales of Products and services offered, prepared nightly deposits, and supervised of tellers. www.statecentral.com(promoted from Teller to Representative to Consultant)Maintained members’ accounts, loan processing and branch balancing- Opened/closed and maintained members’ accounts, Loan Processing, Branch Balancing including security clearance, Cash Verification, Cash Handling, Sales of Products and services offered, prepared nightly deposits, and supervised of tellers.