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Click here or scroll down to respond to this candidateCandidate's Name
Colorado Springs, CO Street Address PHONE NUMBER AVAILABLE EMAIL AVAILABLE LINKEDIN LINK AVAILABLESenior Compliance SpecialistBusiness Solutions Healthcare Compliance Leadership Service ExcellenceAccomplished senior-level healthcare-related compliance professional with extensive experience providing the leadership and direction needed to drive the achievement of key organizational compliance-related goals and objectives. Able to perform detailed analysis and audits to ensure compliance with strict company and industry rules and regulations, producing outcomes that exceed expectations. Proven strength in building long-term, professional relationships with strategic business partners and compliance stakeholders built on open lines of communication and the effectiveness of the recommendation, solutions, and support provided. Recognized for the ability to deliver impactful results while leading in fast-paced, highly regulated environments.Areas of ExpertiseInternal Audits & ControlsResearch & AnalysisTeam TrainingSharepointPerformance AnalysisStrategic Business PartnershipsProject ManagementStandard Operating ProceduresMicrosoft OfficeRegulatory ExaminationsQuality AssuranceRegulatory ComplianceProfessional ExperienceEVERDRIVEN, Greenwood Village, CO 2023 - PresentSenior Compliance SpecialistProvide wide-ranging support in developing a new Compliance Department, meeting with members of other teams to support the creation of the new department.Create and send student and vehicle-related claims to the law firm for the appropriate assignment.Conduct in-depth research of new laws and regulations in relation to student transportation and write new policies and procedures.ALAMEDA ALLIANCE FOR HEALTH, Alameda, CA 2022 - 2023Compliance AuditorCreated new policies and procedures, assisted in developing new report and ordering formats, audited delegated entities, and created and maintained the departments SharePoint website.Provided wide-ranging assistance to the management team with the hiring and training of additional team members.BLUE SHIELD OF CALIFORNIA, Monterey Park, CA 2019 - 2022Senior Business AnalystWrote policies and procedures and created audit tools and job aids as requested.Provided wide-ranging assistance in creating the Industry Collaboration Effort (ICE) Electronic Delegated Entity Information Technology Audit Tool, Audit Process, and Audit Policy.Assigned to audit the Provider Training, assisted with process improvement, and owned and developed the Delegation Operations SharePoint site.Managed ad hoc requests as needed in addition to daily responsibilities and assisted other departments with writing policies and procedures.Responsible for testing completed after policies and procedures, audit tools, and job aids were requested and completed.MOLINA HEALTHCARE, Long Beach, CA 2015 - 2019Research Analyst, (2017 - 2019)Wrote policies and procedures and created audit tools and job aids as requested while being assigned to audit Provider Training.Assisted with process improvement and owned and developed the Delegation Operations SharePoint site.Managed ad hoc requests as needed in addition to daily responsibilities and assisted other departments with writing policies and procedures.Medicare Compliance Auditor, (2015 - 2017)Responsible for full awareness and understanding of CMS requirements related to MAPD and PDP operations and compliance/fraud.Worked independently while performing audits of the departments involved in delivering or administrating MAPD and Medicare Part D plans.Developed custom audit tools, wrote Standard Operating Procedures (SOPs) and job aids as requested, and reviewed and analyzed data before CMS submission.CVS HEALTH, Scottsdale, AZ 2007 - 2014Grievance Senior Consultant, (2014)Conducted in-depth research and analysis of claims data and provided thorough summaries to necessary parties.Served as a liaison for colleagues support and cross-trained and coached colleagues on the department requirements to drive performance improvements.Managed ad hoc inquiries as needed in addition to set daily responsibilities and handled escalated concerns.Compliance Analyst, (2013 - 2014)Defined alleged fraudulent pharmacy contract violations and communicated and educated pharmacy staff on compliance issues.Provided thorough summaries to necessary parties and effectively managed escalated concerns.Network Specialist, Analyst, (2007 - 2013)Responsible for completing and accurately interpreting contract audit requirements and ensuring electronic capture of prescription copies regarding large audits.Responsible for reporting fraudulent claims to the client.Cross-trained and coached colleagues on the departments premier client audit requirements and assisted with research needs as requested across internal business units.Led ongoing premier client conference calls and wrote Standard Operations Procedures (SOPs) and job aids as requested.EducationBachelor of Science, Business Management/Healthcare AdministrationColumbia Southern UniversityAssociate of Science, Business ManagementUniversity of Phoenix |
