Experience

Commonwealth Medicine, UMass Chan Medical School

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

• Medicare Buy-In Quality Review Project Manager

  • Nov 2017 - Present

  Assists in project activities relating to cost savings and revenue initiatives for in- and out-of-state clients of Health Care Finance Solutions' Medicare Eligibility Enhancement Program: Analyzes project data, including large state and federal data sets, to ensure data integrity and security, and identify trends and/or aberrations; Compiles performance statistics from multiple sources to generate invoices and recurring reports. Supports other HCFS units with matters related to pharmacy claims and regulations on an as needed basis, including generating reports and evaluating claims data from POPS and Business Objects.

• Provider Compliance Fraud Investigator

  • Mar 2012 - Nov 2017

  Conducted investigations to determine compliance with state and federal administrative regulations for multiple provider types, including pharmacy and independent nurses for the Health Care Finance Solutions Provider Compliance Unit: Generated and conducted analysis of large data sets from MMIS, Cognos, and Business Objects to monitor provider trends and identify potentially aberrant billing patterns by MassHealth providers; Conducted complete provider reviews including request and comprehensive review of claim history and medical records for compliance with MassHealth administrative regulations; Drafted overpayment notices, pursued recoveries, and prepared cases for referral to external organizations, including the Office of the Attorney General.



ACS, a Xerox Company

• Project Analyst

  • Jun 2010 - Mar 2012

  Acted as liaison between MassHealth and pharmacy providers to facilitate claim submission and promote compliance with MassHealth billing regulations; Created and presented progress reports to clients on a scheduled and ad hoc basis; Oversaw invoicing and reconciliation of the Medicaid Drug Rebate program; Monitored Call Center and Rebate performance and responded as necessary to ensure service was delivered at or above contracted levels; Organized and presented at four annual training events for MassHealth pharmacy providers statewide.



TLC Marketing

• United Kingdom
• Marketing Services

• Account Manager

  • Jan 2007 - Mar 2009

  Managed incentive marketing campaigns for a diverse range of Clients through the United States and Canada; Collaborated with peers, Client contacts and third-party vendors to ensure projects were launched on time and within budget; Drafted copy and guaranteed collateral was presented according to Agency requirements and Client’s brand standards; Provided progress reports at regular intervals and monitored service levels to proactively troubleshoot fulfillment challenges Managed incentive marketing campaigns for a diverse range of Clients through the United States and Canada; Collaborated with peers, Client contacts and third-party vendors to ensure projects were launched on time and within budget; Drafted copy and guaranteed collateral was presented according to Agency requirements and Client’s brand standards; Provided progress reports at regular intervals and monitored service levels to proactively troubleshoot fulfillment challenges



Sage Systems

• United States
• Technology, Information and Internet
• 1 - 100 Employee

• Operations Associate

  • Sep 2004 - Nov 2006

  Supported more than fifty political campaigns throughout the United States; Cultivated positive relationships with Clients and their staff at all levels; Provided around-the-clock support and training via email, telephone and in person; Worked with a customized CRM tool to assist Clients with voter targeting, contact management and filing of state and federal finance reports; Coordinated annual User conference including venue selection, developing training materials and making presentations on site; Organized effective proposals and marketing collateral from start-to-finish by editing copy from multiple sources to reflect a single voice and used Microsoft Word, Excel and PowerPoint to present materials effectively



US Department of Justice, FBI

• Information Management Assistant

  • Jul 2002 - Aug 2004

  Worked with government-classified and Grand Jury materials on a daily basis; Performed administrative functions including case management, lead assignment and receipt of evidence and other collected items; Efficiently handled various filing task responsibilities; Maintained case files and evidence logs; Transcribed official documents for use in Grand Jury proceedings; Executed database searches and organized results for use in official communications and case reports Worked with government-classified and Grand Jury materials on a daily basis; Performed administrative functions including case management, lead assignment and receipt of evidence and other collected items; Efficiently handled various filing task responsibilities; Maintained case files and evidence logs; Transcribed official documents for use in Grand Jury proceedings; Executed database searches and organized results for use in official communications and case reports



Commonwealth of Massachusetts

• United States
• Government Administration
• 700 & Above Employee

• Help Desk

  • May 2000 - Jul 2002

  Provided technical support for the statewide voter registration database to the City and Town clerks of the Commonwealth; Coordinated the implementation of redrawn precinct data into the database; Completed special projects as assigned by Superiors Provided technical support for the statewide voter registration database to the City and Town clerks of the Commonwealth; Coordinated the implementation of redrawn precinct data into the database; Completed special projects as assigned by Superiors