Experience

Health Partners Plans

• United States
• Hospitals and Health Care
• 300 - 400 Employee

• Manager

  • Oct 2011 - Present

  Experience with regulatory compliance analysis, project management and call center operations. Comprehensive understanding of operations with focus on implementation of Medicare, Medicaid and CHIP policies and procedures Experience with HIPAA, and fraud and abuse Experience with CMS Audit protocolsDirect the daily operations of the Medicare, Medicaid and CHIP telephone unitDirect a cross-functional team to meet and exceed service requirements and functional objectives Recruit, develop, motivate and retain a high caliber team Maintain a positive work environment that supports self-direction; provide a structure to optimize experience, skill knowledge and capabilities of the team. Maintain and foster a collaborative relationship with internal and external customers Coordinate projects with regulating agencies and act as a liaison as directed by Director/VP Member Relations Research, analyze and implement all directives received via HPMS, CMS, MLN memoranda and other regulatory agencies and adjust departmental processes accordingly. Ensure departmental compliance with Medicare reporting including data validation requirements and Star quality rating reporting requirements Possess a broad and deep understanding of the Medicare, Medicaid and CHIP health care environmentsCollaborate with compliance team, legal department, and 5 Star Quality team to fulfill regulatory compliance requirements and corporate goals Develops and implement new programs or best practices and strategies which improve the quality care to our members. Participate in CMS, MLN Continuing Education programs annually as to remain abreast of industry changes Research CMS best practices and common findings and implement, as appropriate.



Quest Diagnostics

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

• Group Leader

  • Nov 2003 - Oct 2011



Lakeside Community Healthcare

• Claims Specialist

  • 1998 - 2001



Highmark Blue Cross Blue Shield

• Senior Claims Examiner

  • Apr 1991 - May 1996