Courtney Berard
Manager, Operations Compliance at Delta Dental of Minnesota- Claim this Profile
Click to upgrade to our gold package
for the full feature experience.
-
English -
Topline Score
Bio
Credentials
-
Confronting Bias: Thriving Across Our Differences
LinkedInJul, 2021- Nov, 2024
Experience
-
Delta Dental of Minnesota
-
United States
-
Insurance
-
200 - 300 Employee
-
Manager, Operations Compliance
-
Sep 2023 - Present
-Provide leadership, direction and hands-on management to Operations Analysts -Develop and execute audit scope and schedule-Develop internal audit processes to monitor policy changes, compliance and corrective action plans-Ensure that regulatory requirements and standards are understood by the operational/business areas-Research business area compliance issues and recommend changes that assure compliance with State, Federal, and client contract requirements-Participate in work projects and committees applicable to Compliance, Risk Management, Privacy, Security, and other groups Show less
-
-
Government Programs Team Lead
-
Mar 2022 - Oct 2023
Provide leadership, direction and hands-on management to Government Program Advocates and Quality Analysts.Develop and execute Federal, State, and Client audit scope and scheduling for varying lines of business. Develop internal audit processes to monitor policy changes, compliance and corrective action plans.Solicit and collect client feedback and recommend improvement opportunities.
-
-
-
Fairview Health Services
-
United States
-
Hospitals and Health Care
-
700 & Above Employee
-
Compliance Coordinator
-
Sep 2021 - Mar 2022
Oversee the administration of the Corporate Compliance Hotline. Assist the System Director of Compliance, System Director of Privacy and Investigations, and the Chief Compliance Officer with the overall coordination of the Compliance Program. Build and maintain relationships with internal and external customers. Oversee the administration of the Corporate Compliance Hotline. Assist the System Director of Compliance, System Director of Privacy and Investigations, and the Chief Compliance Officer with the overall coordination of the Compliance Program. Build and maintain relationships with internal and external customers.
-
-
-
Delta Dental of Minnesota
-
United States
-
Insurance
-
200 - 300 Employee
-
Government Programs Advocate
-
Jun 2018 - Sep 2021
Collaborate with and account manage for Minnesota Managed Care Organizations and Department of Human Services. Develop and execute stakeholder, downstream entity, state, and federal audits; including Corrective Action Plan follow-up. Manage stakeholders concerns and escalated issues. Work cross-functionally with other departments and Third Party Administrators to ensure Compliance with Federal and State Medicaid and Medicare regulations. Validate and correct systems setup following transitional changes.Project manage systems changes including regulatory letters and provider fee changes. Provide Government Programs expertise across departments and for dental providers. Member of Minnesota Department of Health Administrative Uniformity Committee and FQHC/RHC research group. Show less
-
-
Government Programs Coordinator
-
Mar 2017 - Jun 2018
Provide expertise to internal staff regarding government program policies and procedures. Assist Government Programs Manager in facilitating day-to-day operations for Delta Dental’s Medicaid and Medicare lines of business. Monitor and audit Delta Dental’s external service administrator to ensure delivery of tasks in a timely, quality and compliant manner. Coordinates across internal departments on matters related to government programs.Create and utilize a Quality Assurance program across dental networks. Ensure Delta Dental is meeting and following federal and state laws as related to Government Programs. Show less
-
-
-
Medica
-
United States
-
Insurance
-
700 & Above Employee
-
Compliance Analyst
-
May 2014 - Jan 2017
Maintained thorough understanding of compliance laws and regulations in government programs Initiated process improvements for reporting procedures Collaborated with other departments to create a macro to breakout excel spreadsheets Decreased process time by 1 hour through use of a macro and canned messaging Created spreadsheets that were uniform to allow for faster editing and removal of unused data Maintained high level of knowledge in the Benefit Exception and Denial, Termination and Reduction processes as well as the benefit set of State Public Program members Received internal promotion to begin working with Care Coordinators to process Long Term Care Consults into databases including the Department of Human Service’s MMIS and internal CCMS Skilled at prioritizing work and paying attention to detail in order to maintain compliance Assisted in creating new processes to help maintain compliance timelines Completed and reviewed internal audits to verify compliance regulations with letters sent to members and providers Maintained thorough understanding of both the Department of Human Services as well as Centers for Medicare and Medicaid regulations for compliance Performed Case Management of Behavioral Health Home enrollment and disenrollment Show less
-
-
-
UCare
-
United States
-
Hospitals and Health Care
-
700 & Above Employee
-
Member Services Specialist Senior
-
Nov 2011 - Apr 2014
Responded to all member inquiries that come in through our voice message system, mail, TTY, online, in person and other escalations Received further training in systems other than multi-line phones. i.e. TTY Managed escalated requests that required in-depth research into member accounts Received promotion from a State and Public Program representative to be cross-trained in Medicare and a Senior Representative Solved problems effectively, worked cross-functionally with other departments, providers, the Department of Human Services and Centers for Medicare and Medicaid to reach resolution Documented all touch-points in members’ files to effectively show what was completed or needs further attention. Clearly communicated the necessary information Assisted members on Minnesota Senior Health Options, Minnesota Senior Care Plus and Special Needs Basic Care plans and their coordinators in things such as waivered services and claims denials due to coding issues. (ICD-10) Interacted with a diverse population of members and be able to relay information that they can understand Managed a work list efficiently to complete tasks in a timely manner to make sure the members received responses to their questions within compliance as regulated by Centers for Medicare and Medicaid Show less
-
-
-
-
Site Leader
-
Sep 2006 - Nov 2011
Supervised 5-15 diverse staff members on a daily basis Designed and implemented a school-aged child curriculum that includes disability and diversity awareness curriculum Worked to create an all-inclusive environment for children of all age ranges and abilities as well as diverse staff skills and abilities Managed an inclusive program for children ages 5-11 Worked with children in our program on the autism spectrum as well as many children with varying diagnosis including ADHD Certified and maintained certification during employment of CPR and AED as well as CPI Nonviolent Crisis Prevention trained Maintained confidentially of the students and families in the program with my staff and the school staff we partnered with as well as my staff members Show less
-
-
Education
-
2014 - 2017
St Mary's University of Minnesota
Master's Degree, Human Development -
2006 - 2011
St. Catherine University
Bachelor of Science (B.S.), Social Work
Community
