Compliance Officer

• Jan 2023 - Present

Estimating and Compliance Manager

• May 2021 - Dec 2022

Quality Coordinator

• Nov 2020 - May 2021

Paradigm is an accountable care management organization focused on improving the lives of people with complex and catastrophic injuries and diagnoses. We have been a pioneer in value-based care since 1991, offering deep clinical expertise, high-value specialty networks, behavioral health support, payment integrity solutions, and robust data analytics to generate the very best outcomes for patients, payers, and providers. Paradigm is headquartered in Walnut Creek, California, with offices across the U.S. For more information, please visit www.paradigmcorp.com.* Responsible for supporting the Special Programs Unit through assignment of projects, including but not limited to quality assurance, customer billing audits, quality reviews, data analysis, customer guideline maintenance. * This position communicates and works with multiple departments within Paradigm to ensure quality services.* Maintaining current knowledge and updating departmental documentation of worker's compensations laws for all jurisdictions. Show less

Customer Implementation Specialist

• May 2018 - Nov 2020

• Oversees the daily functions and workflow of the Customer Implementation Team• Manages projects and tracks progress as assigned• Develops and maintains information storage system/archives• Works with internal and external customers as needed to implement customer directives.• Development of QA program for CIT and oversee QA performed at regular intervalsParadigm is the industry leader in solving complex health care challenges and improving lives for injured workers. For almost 30 years, we've set the standard for outcomes-focused care for workers' compensation cases involving the most challenging catastrophic injuries. Show less

Business Development and Compliance Manager

• Feb 2013 - May 2018

• Oversee the Business Development Specialist and Business Development Analyst positions. To include but not limited to all invoice review, Sales support, and CEU’s. • Oversee coordination of Customer Contracts, Business Contracts, and Service Agreements. Includes overview and implementation of new contracts in a timely manner with appropriate parties to meet specific deadlines. Includes maintenance to ensure communication with sales related to expiration dates and customer rates are reviewed in a timely manner. Includes engaging the Controller in a timely manner. • Ensure rate comply with contract/service agreements and other standard rate agreements. • Responsible to ensure Encore Unlimited Certifications (i.e. URAC, WBENC, IL Female Business, etc.) are maintained and renewed efficiently and housed for easy access.• Member of core group to develop URAC approved policies and procedures as Encore was getting URAC accreditation.• Member of the Regulatory Compliance committee which requires quarterly phone conferences, review regulatory and jurisdictional websites and send out any new information to appropriate regulatory committee member for review.• Coordinated network partner relationships. Responsibilities include networking to ensure network relationships are in place where geographic coverage is needed, the network contracts and pricing is reviewed on a regular basis and coordinate day to day referrals with Encore operations and/or sales staff. Duties also include coordinating the report/invoicing process.• Oversee maintenance of existing State licensures and facilitate new licenses when applicable. Includes registration with National Registry.• Member of the Encore Training cross disciplinary committee to facility ongoing improvement related to quality delivery. • Member of Core Team for corporate software development/implementation/training for Encore. Show less

Sales and Marketing Coordinator

• Jul 2008 - Feb 2013

• Provided day to day support to sales staff. Duties included special requests, assistance with Request for Proposals, account presentations (creating in Power Point), coordinate scheduling of conferences and ensure appropriate materials are received as requested.• Maintained account special instructions, ensuring rate tables in software are accurate, customers reports are run and delivered promptly, coordinate customer auditing requirements, and work with various divisions to ensure that savings reports are distributed timely.• Coordinated network partner relationships. Responsibilities include networking to ensure network relationships are in place where geographic coverage is needed, the network contracts and pricing is reviewed on a regular basis and coordinate day to day referrals with Encore operations and/or sales staff. Duties also include coordinating the report/invoicing process. Show less

Team Leader

• Mar 2006 - Jun 2008

• Leadership and Coaching o Coordinated and provided cross training and development opportunities for assigned administrative staff members to cover needed areas due to vacations, absences, etc. under direction and assistance of the Operations Manager. o Led assigned administrative staff by providing examples of solid preferred behavior by using the Encore mission statements and proper leadership traits and qualities. o Implemented quality in all areas of work performed and helped encourage the same among the administrative staff.• Reports/Invoicing o Ensured accurate and timely distribution of reports and invoices by assigned administrative staff and ensure proper procedures as defined by Management. o Gathering and performing necessary QA functions when relevant and asked by Management.• Referrals o Ensure accurate timely distribution of referrals by assigned administrative staff and ensured proper procedures as defined by Management in relation to this job function are being followed. o Coordinate network referrals and ensures proper notification of necessary information to administrative staff.• Software o Developed/implemented/tested/trained new Eximius software to all staff and case managers.• Marketing/Sales Support o Daily support of Account Executives to include special requests, generating quarterly customer reports, and other activities as assigned. o Provide support for RFP’s and account presentations.• Technology Support o Assist in providing technical support to Encore staff by resolving issues within 24 to 48 hours of receipt.• Website o Maintained accurate and timely updates related to changes in case manager information.• Management Reports o Assisted in coordination of standardizing reporting tools in an effort to reduce redundancy and time spent gathering reporting. Show less

Operational and Sales Specialist

• Jul 2001 - Feb 2006

• Referrals – receiving and processing referrals that came in for case managers.• Provided IT support for case managers regarding Microsoft Office products and miscellaneous other requests.• Sales Support • Processing report and invoices for all case management staff.• Website development and maintenance• Responsible for maintaining all corporate training manuals for the company.

Operational Specialist

• Jun 1994 - Jun 2001

In this role I worked as a referral coordinator, processed reports and invoices for case managers, provided IT support to all case managers, and provided support to sales team members. In this role I worked as a referral coordinator, processed reports and invoices for case managers, provided IT support to all case managers, and provided support to sales team members.

Claims Processor and Claims Adjuster

• 1989 - 1994