Experience

ATTAC Consulting Group (ACG)

• United States
• Business Consulting and Services
• 1 - 100 Employee

• Consultant

  • Jul 2022 - Present



Presbyterian Healthcare Services

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

• Manager, Utilization Management Quality Assurance Regulatory and Reporting

  • May 2019 - May 2022

  • Performs on-going compliance audits utilizing as necessary, state evaluation tools relating to audit/monitoring activities. Responsible for regulatory monitoring, external audits, external reports, and internal monitoring for the Utilization Management department. Manages the preparation for accreditation and regulatory audits, including the interpretation of standards and development of mechanisms for monitoring compliance for the departments. • Identifies and defines audit scope and criteria, reviews and analyzes evidence, and documents audit findings, including making recommendations for improvement and correction where identified. Manages, conducts, and maintains compliance activities to ensure the department is compliant with all CMS, HSD, and OSI regulatory requirements and NCQA accreditation standards. Develops, monitors, and updates internal and external corrective action plans related to internal and external audit outcomes. • Performs comprehensive, complex technical regulatory analysis, including the review, summarization and dissemination of regulatory updates and changes to the business. • Assists with monitoring activities involving the effective execution of corrective action requirements imposed by state or federal regulatory agencies for contract deficiencies. Writing technical specifications for internal and external reports and universe development. Developing tools for internal audit and monitoring activities, including dashboards, metrics, reporting, and audit tools.• Responsible for regulatory reporting including monitoring for new reports and changes to existing reports; leading report development of new reports; implementing new reports and report changes; compiling all data and analysis for regulatory required reporting, including reviewing data for accuracy, resolving inaccurate data, providing feedback to operations, compiling final reports, and delivering reports in accordance with report specifications. Show less

• Training Specialist II

  • Oct 2018 - May 2019

  • Delivered group and individual instruction and training covering a range of technical and operational areas. Coordinated and performed administrative functions necessary to deliver and document training programs. • Assisted in analyzing and assessing training and development needs for individuals and clients. Assisted with developing training curricula and material with the Clinical Trainer.• Accomplishments: - To ensure training material consistency, created a training template and associated desktop for training material development. Show less

• Supervisor - Clinical Operations Audit/Internal Monitoring Team

  • Jan 2017 - Oct 2018

  • Assisted the manager with organizing and conducting audit activities to ensure the Utilization Management and Care Coordination teams satisfied regulatory requirements for CMS, HSD, NCQA, and Quality Review Organization audits. • Assisted the manager with development, monitoring, and updating internal and external corrective action plans related to audit outcomes. Coordinated with the manager on all audit results and audit-related projects to support and ensure consistency of practice and decision making. • Manually calculated regulatory and accreditation timeliness for UM and reported the results to UM leadership in a performance dashboard monthly.• Accomplishments: - Reviewed and interpreted timeliness requirements for UM in order to develop a monthly timeliness report that was completed manually each month. This process was created to provide the UM leadership a report to assist with monitoring timeliness and processes. Show less

• Clinical Operations Auditor

  • Nov 2015 - Jan 2017

  • Assisted with auditing and compliance activities to ensure the Utilization Management and Care Coordination teams met regulatory requirements for CMS, HSD, NCQA, and Quality Review Organization compliance. • Monitored, reviewed, and audited utilization management and care management case records for all product lines to ensure accuracy and compliance with policies, procedures, accreditation standards, and regulatory requirements. • Assisted with the development and modification of internal audit tools to measure regulatory compliance. As directed, revised audit tools as standards and regulatory requirements changed. Assisted with tracking and trending the results for improvement opportunities. • Assisted in preparation for accreditation and regulatory audits, including the interpretation of standards and regulations. • Assisted with activities and prepared files to support accreditation and regulatory audits for all product lines.• Accomplishments: - Developed the standard audit tool Microsoft Excel for the team to use when completing internal monitoring. These audit tools included scoring for each individual case audited as well as a total audit score and a summary tab with graphs and tables to show improvement overtime. Show less



HealthInsight

• United States
• Hospitals and Health Care
• 1 - 100 Employee

• Project Manager

  • Jul 2015 - Nov 2015

  • Managed the planning, development, implementation, evaluation, and improvement of the Cardiovascular Project. Fulfilled all contract requirements and deliverables for the Cardiovascular Project. • Developed and managed project work plans, budgets, and reports as required. • Developed, delivered, and evaluated training for internal and external customers as required. • Developed intervention materials for project activities.• Prepared articles and reports for external publications and represented HealthInsight New Mexico before various audiences. • Updated contact information in the Contact Management Database as appropriate. Developed and maintained positive relationships with internal and external customers. • Represented HealthInsight New Mexico in local, state, and national committees, conferences, and health fairs as appropriate.• Accomplishment: - Recruited and signed up all required primary care practices that were interested in improving their Cardiovascular PQRS or Meaningful Use data requirements. Show less

• Continuing Medical Education (CME) Coordinator

  • Jul 2008 - Nov 2015

  • Managed the Continuing Medical Education (CME) program to ensure the program is in compliance with the required Accreditation Council for Continuing Medical Education (ACCME) criteria. Developed and maintained the CME policy and procedures. Coordinated and provided assistance with the application process and timeline adherence for internal and external customers.• Accomplishments: - Worked with IT staff to design, develop, and implement a CME portal to provide online CME training, assessment, and validation. - Improved the tracking of CME events, participation, and credits by developing a database in Microsoft Excel. This database was used to populate letters, certificates, and mailing labels to send to the members. - Coordinated and finalized CME reaccreditation applications to secure two four-year awards for state-level continuing medical education accreditation through the New Mexico Medical Society (NMMS). - Implemented an electronic application review process for the CME committee in order to increase efficiency and provide electronic documentation of decisions and committee feedback. - Created a separate electronic application for each of six categories of CME activity, in order to simplify the application process. Show less

• Project Coordinator

  • Mar 2009 - Jul 2015

  • Worked with project managers under minimal supervision to fulfill all contracts and grant requirements. • Collaborated with project team to plan, develop, implement, monitor, and evaluate progress on assigned projects. • Performed root cause analysis where data analysis indicated improvements were needed. Provided consultation, hands-on assistance, and technical expertise to physician practices and vendors in the use of electronic health record systems and the enhancement of reporting and care management functions.• Accomplishments: - Completed full recruitment on contracts and grants. - Developed a progress report in Microsoft Excel to illustrate the progress and status of the deliverables. - Designed and implemented a reporting toolkit for the physician practices to extract data from the electronic health record, facilitating data submission and review for quality improvement opportunities. - Created and implemented a virtual technical assistance method by using webinar software and teleconference lines to reduce cost and increase productivity. In 2011, presented this process at a CMS Conference in Baltimore to demonstrate creativity to reduce cost and increase productivity with the work required by CMS. - Provided training and support to internal staff on the contact management database, business software, and processes to assist with consistency and efficiency on current projects. Show less

• NMHITREC Project Coordinator

  • May 2010 - Jan 2013

  • Assisted the physician offices in the state of New Mexico to achieve “meaningful use” of their EHRs through Medicare and Medicaid EHR Incentive Programs. • Provided technical assistance (virtual and face-to-face) as well as educational material to each clinician.• Accomplishment: - Developed an internal process and procedure manual for the New Mexico Health Information Technology Regional Extension Center (NMHITREC) project to coordinate project work between the three participating organizations. Show less

• Administrative Assistant

  • Jun 2006 - Mar 2009

  • Assisted four project managers and teams on three different contracts with CMS and HSD. • Attended all team and manager meetings to take minutes or notes for documentation for each contract. • Assisted managers with all material development, finalizing, and producing the final product as needed. • Assisted with all hosted events to include distribution of invitation, setting up the room (technical and physical setup), and greeting the guests.• Accomplishment: - Assisted with design and troubleshooting of a Customer Management Database (CMD). Developed a CMD user guide to train new employees as well as a reference guide for the current staff. - Developed an Overall Training Manual for new employees called a “Buddy Training Manual” including overviews of commonly used organizational processes and procedures. - Created and implemented an event planning process with an accompanying user checklist to help ensure consistency and efficiency. Show less



Kleenrite, Inc.

• Albuquerque, New Mexico Area

• Administrative Assistant

  • Dec 2005 - May 2006

  • Established, updated, and maintained project files, inventories, direct suspense items and records; implemented and maintained project management systems. Reviewed and audited files in preparation for scanning into the computer system. • Performed a wide range of administrative activities for the business such as answering the telephone, assisting with resolving problems and inquiries of visitors, ordering supplies, maintaining records, making forms, labels, photocopying, faxing, operate office equipment, and utilizing the computer systems. Prepared invoices, reports, memos, letters, financial statements, and other documents by using Word, Excel, Access, and PowerPoint. • Coordinated warehouse shipments and deliveries which included generating incoming and outgoing purchase orders. Coordinate and communicate international shipments to distributors monthly which include research and resolve distributors issues. • Provided outstanding customer services. Show less



The University of New Mexico

• United States
• Higher Education
• 700 & Above Employee

• Program Support Staff (work-study) - Registrars Office

  • Oct 2005 - Dec 2005



Central New Mexico Community College

• United States
• Higher Education
• 700 & Above Employee

• Distance Learning Assistant (work-study)

  • Mar 2004 - Apr 2005