Experience

CoventBridge Group

• United States
• Security and Investigations
• 300 - 400 Employee

• Program Integrity Analyst II

  • Jan 2022 - Present

  Review information contained in standard claims processing system files (e.g., claims history, provider files) to determine provider billing patterns and to detect potential fraudulent or abusive billing practices or vulnerabilities in Medicare and Medicaid policies and initiates appropriate action. Compile and maintain documentation and information related to investigations, cases, and/or leads. Develop and prepare potential fraud alerts and program vulnerabilities for submission to CMS; share information on current fraud investigations with other Medicare and Medicaid contractors, law enforcement, and other applicable stakeholders.



Florida Department of Health

• OPS Medical Malpractice Investigator

  • Aug 2019 - Dec 2021

  Liaise with law officials to identify and prosecute unlicensed healthcare professionals and medical negligence via investigations. Ensure healthcare workers align with local and national policies and regulations by implementing uniform laws for unlicensed activity. Investigate complaints on malpractices by reviewing hospital records, lab reports, and court records. Develop reports on results of probation, supplemental, and final investigations. Preparation and service of Cease and Desist and Agreements as well as Citations.

• OPS Investigative Specialist II

  • Feb 2018 - Aug 2019

  Conducted new, routine, and change of location inspections on various licensed healthcare facilities. Analyzed prospect legal violations or criminal activity at existing facilities. Advocated for best practices and coordinated with legal authorities to enforce healthcare licensing. Interviewed parties involved in investigation and compiled research on complaints to develop Investigative Memorandum reports. Attended civil court proceedings to demonstrate findings.



City of Sugar Land

• Public Safety Dispatcher

  • May 2017 - Jan 2018

  Provided emergency contact support by managing calls from public residents. Assisted callers by identifying needs, providing comprehensive judgement, and dispatching emergency responders, and delivering instruction. Collected and recorded emergency details by utilizing software tools. Operated telecommunications systems and maintained emergency records. Provided emergency contact support by managing calls from public residents. Assisted callers by identifying needs, providing comprehensive judgement, and dispatching emergency responders, and delivering instruction. Collected and recorded emergency details by utilizing software tools. Operated telecommunications systems and maintained emergency records.



Transcore

• Quality Assurance Auditor

  • Sep 2014 - May 2017

  Analyzed EZtag toll road transactions with electronic devices to ensure systems integrated accurately. Reviewed axle counts and oversaw charges to ensure accuracy. Compiled and entered data by utilizing MS Office tools, including MS Excel and Word. Ensure audit results align with project deadlines in coordination with Team Leaders. Developed documents to record audit results. Presented audit results to Supervisors. Analyzed EZtag toll road transactions with electronic devices to ensure systems integrated accurately. Reviewed axle counts and oversaw charges to ensure accuracy. Compiled and entered data by utilizing MS Office tools, including MS Excel and Word. Ensure audit results align with project deadlines in coordination with Team Leaders. Developed documents to record audit results. Presented audit results to Supervisors.



DISH Network

• United States
• Telecommunications
• 700 & Above Employee

• Universal Customer Service Specialist

  • Jun 2009 - Apr 2013

  Interacts with customers via telephone to assist with a variety of customer inquiries and issues. Corrects errors and discrepancies on customers' billing statements as necessary. Explains billing cycles, processes, and prorates effectively to ensure that customers understand their statements. Establishes rapport and promotes effective relationships with the customers. Demonstrate an awareness of company policies and procedures while applying sound judgment. Prepare work orders accurately; processes payments and enters credit card information accurately. Support other lines of business as call volume dictates. Achieve overall call center performance goals, while impacting the business goals of the organization.