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Click here or scroll down to respond to this candidateCandidate's Name
Street Address PHONE NUMBER AVAILABLE EMAIL AVAILABLESUMMARY:Successful professional with over 19 years of experience in contract compliance, Health care industry,finance, human resources, insurance claims litigation, sales and customer service. Participated inmultiple legislative encounters. Experienced in legal research and analysis. Consistently demonstratesstrong analytical skills with the ability to drive change to help achieve enterprise goals. A dynamic teamplayer with well-developed written and verbal communication abilities, accustomed to performing in adeadline driven, multi-tasking environment, with a drive to learn new things.HIGHLIGHTS:Contract Oversight and ComplianceHealthcare IndustryInsurance Claims LitigationBudget and FinanceClient/Vendor RelationsProject ManagementLegal Research and AnalysisPROFESSIONAL EXPERIENCE:WVCorp/VACorp, Roanoke, VA2021 to Present- West Virginia Litigation SpecialistHandle the entire state of West Virginia in litigation matters, such as Public Officials Liability, Law Enforcement Liability, General Liability and Bodily Injury.Reviewed all complaints filed, summarized and assigned to our defense attorneys.Compiled reports for management to review for each claim, such as pre-mediation and pre-trial. Provided analysis for each suit to management. Ensured the Medicare/Medicaid laws were being followed.WVU Medicine/Hospitals, Morgantown, WV2020 2021 - Reimbursement Specialist2018 Human Resource Specialist ContractorFunction as a liaison between departments within WVU Hospital System and WVU Hospitals Finance department.Extensive knowledge of third party reimbursement as it relates to provider based clinics and medical education related to Medicare reimbursement.Reviews and interprets all new reimbursement legislation related to Medical Education and communicates changes to management. Educates Resident Coordinators on changes in Medicare regulations.Coordinates the annual Medicare audit related to Medical Education reimbursement. Ensures that all required data is available and accurate. Responds to and resolves audit issues in a timely manner.STEPTOE & JOHNSON, PLLC, Bridgeport, WV2018 2020 Legal Assistant - LitigationProvided support to assigned attorney(s) and paralegal(s) through performance of complex clerical duties requiring knowledge of legal terminology and the legal process and Health Insurance Portability & Account Ability Act (HIPPA).Write legal documents and conduct research for oil and gas leasesHandle strict confidential client and firm data in a professional and ethical manner.Manage data and prepare presentations.PDC Energy, Bridgeport, WV2017 Human Resource Specialist ContractorCompleted a broad range of advanced skills and expertise in the full range of federal HR areas including but not limited to staffing, classification, processing, benefits, recruitment, compensation, policy and employee and labor relations.Reviewed and analyzed salaries and bonus targets for all departmentsUpdated the job descriptions for over 250 positions throughout various departments to include job duties and key values.Mylan Pharmaceuticals, Morgantown, WV2015-2017 Pricing and Contracts Compliance SpecialistPerformed as the lead and provided project oversight (budget, schedule and scope) on the implementation of new training programs within the organization.oPerformed end user testingParticipated in a requirements development team to implement new employee program.oGathered requirements from staffoWorked with outside vendors to develop a new onboarding programEffectively managed 42 accounts, which included one of the largest accounts in the entire company.Collected, interpreted and analyzed pricing data regarding Mylan Pharmaceutical sales of contracted products in retail pharmacies.Collected, organized, and interpreted numerical and statistical data regarding Mylans contract terms, pricing structures, organizational information, decision making processes, relevant company information such as financials and quarterly/annual reports, and overall customer performance.State Farm Insurance, Fairmont, WV1999-2015 Claims SpecialistHandled litigation for bodily injuries and reviewed all documentation necessary to discuss and negotiate with attorneys about the mechanism of injury in an attempt to reach settlement without going to trial.Compiled reports for management to review for each claim. Provided analysis for each injury to management. Ensured the Medicare/Medicaid laws were being followed.Served as a liaison to the public, medical providers, governmental entities, and law enforcement agencies on insurance issues and compliance requirements.EDUCATION:University of California, Irvine Online - 2020Project Management CoursesoInitiating and planning projectsoBudgeting and scheduling projectsFairmont State University 1201 Locust Ave. Fairmont, WV, 26554Regents Bachelor of Arts; Psychology, 1998Cornell University Therapeutic Crisis Intervention Certification, 1999MJ |
