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Click here or scroll down to respond to this candidate Candidate's Name , CPhT, MBA
Chicago, Illinois | PHONE NUMBER AVAILABLE | EMAIL AVAILABLE | LinkedIn Profile
~ REGULATORY AND COMPLIANCE CONSULTANT / MANAGER ~
HEADLINE: Seasoned, performance-driven, and multifaceted Regulatory Compliance Expert: Demonstrated proficiency in
contracting, provider education, quality assurance, and process improvement, ensuring adherence to industry standards.
QUA L IF IC ATI O NS P ROF I LE
Strategic Consultant: with stellar reputation in providing strategic guidance to organizations, identifying regulatory
challenges, and implementing tailored solutions to optimize compliance processes.
Effective Risk Management Professional: with proven track record of introducing robust risk management strategies,
safeguarding organizations from potential regulatory pitfalls, and ensuring regulatory excellence.
Passionate Customer Advocate: recognized for commitment to understanding clients' unique needs and challenges,
delivering customized consultancy services, and fostering long-term partnerships built on trust and mutual success.
Continuous Process Improvement Driver: dedicated to staying abreast of regulatory changes and industry best
practices, continuously seeking opportunities to enhance compliance frameworks and drive operational efficiency.
CO RE CO MPE TE NC IE S
Strategic Partnership Development | Revenue Growth Strategies | Contractual Negotiation | Market Insights Utilization |
Claims Processing Optimization | Financial Analysis | Performance Evaluation Metrics | Team Leadership | Employee
Engagement Initiatives | Interdepartmental Collaboration | Regulatory Compliance | Continuous Process Improvement |
Client Relationship Management | Inventory Control | Supply Chain Optimization | Efficient Delivery Systems | Customer
Outreach Initiatives | Data Accuracy and Integrity | Legal Document Processing | Debt Recovery Strategies | Case Resolution
| Financial Forecasting | Research and Analysis | File Retrieval | Project Management | Risk Mitigation Strategies
P ROF ES S IO N A L E XP E RI ENC E A ND IM PA CT
BLUE CROSS AND BLUE SHIELD Illinois, Montana, New Mexico, Oklahoma & Texas: 2019 Present
PROVIDER NETWORK CONSULTANT, GOVERNMENT AND COMMERCIAL LINES OF BUSINESS Aug 2022 Present
Drove a 50% revenue increase and elevated industry presence by orchestrating productive engagements with
physician groups, leveraging market insights to secure lucrative contractual partnerships.
Achieved a 25% reduction in claims processing time and a 10% revenue boost through streamlined report posting and
efficient repricing strategies in collaboration with Finance and Reimbursement teams.
Attained 30% increase in provider compliance by identifying critical areas for improvement and executing targeted interventions.
Expedited claims processing time by 20% and enhanced revenue cycle management efficiency through accurate
submission of encounter data in partnership with government and commercial lines of business.
Improved revenue cycle and lessened claim denials through increased provider knowledge and adoption of best practices.
SUPERVISOR SUBSCRIBER SERVICES COMMERCIAL CLAIMS, CHICAGO AREA Oct 2020 Aug 2022
Heightened customer satisfaction ratings by 20% increase and accelerated claim resolution time by 15%, mentoring a team of
20+ claim examiners to consistently exceed claim handling metrics, quality standards, and customer service expectations.
Reached 20% boost in employee engagement through targeted recognition and rewards for top performers and
pioneering robust performance evaluation process utilizing Tableau and metrics.
Mobilized 15% increase in overall departmental productivity and 40% decrease in claims process bottlenecks by
fostering strong interdepartmental relationships and maintaining open communication.
Realized annual cost savings of $1.2M by accurately identifying eligible benefits and enhancing claim processing efficiency.
TEAM LEAD, PHARMACEUTICAL CARE MANAGEMENT, CHICAGO AREA Nov 2019 Oct 2020
Propelled 25% enhancement in employee productivity by implementing tailored learning modules and weekly
performance evaluations in conjunction with stakeholders and vendors.
Cut down error rates by 30% and increased customer satisfaction by 20%, orchestrating regular performance
assessments and providing actionable feedback.
Maximized team performance by 25% through interviews and evaluation of candidates' technical expertise and soft skills.
Elevated customer satisfaction ratings by 15%, ensuring adherence to guidelines, and driving continuous
improvement, resulting in identifying and rectifying quality gaps.
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Candidate's Name , CPhT, MBA
Chicago, Illinois | PHONE NUMBER AVAILABLE | EMAIL AVAILABLE | LinkedIn Profile
PHARMACY OPERATION, PHARMACEUTICAL CARE MANAGEMENT, CHICAGO AREA Apr 2019 Nov 2019
Showcased exceptional analytical skills in MTM cases to pinpoint eligible members for CMR, resulting in a 40%
increase in CMR completion rates among eligible members.
Engaged with 50-100 qualifying members monthly and delivered exceptional CMR service experience through
extensive Pharmacist callbacks and targeted outreach initiatives.
Decreased adverse drug events by 30% and optimized medication management processes by partnering with
pharmacists to review and advise clinicians and PSAs on case resolutions.
Intensified medication adherence by 15% and patient outcomes by 25%, leveraging medical claims insights to
proactively identify optimization opportunities in MTM and quality programs.
CVS SPECIALTY Mount Prospect, IL: 2017 2019
TRAINER/SUBJECT MATTER EXPERT Sep 2018 Apr 2019
Slashed training costs by 25% and accelerated onboarding process by 40%, orchestrating comprehensive orientation classes
for new pharmacy service representatives (PSRs) and pharmacy techs while ensuring 100% compliance with SOPs.
Streamlined handling time by 25% and fortified patient satisfaction ratings by mentoring 15-30 new hires, emphasizing
'One Call Resolution' to optimize performance.
Advanced employee self-sufficiency and adoption of digital resources by delivering engaging training sessions on
essential platforms such as the Source, LearnNet, HBS, SPARCS, company website, and H.R. systems.
PHARMACY SERVICE REPRESENTATIVE Nov 2017 Sep 2018
Shortened processing time by 30% while maintaining a 99% accuracy rate by closely monitoring over 1500
prescriptions and refills monthly with meticulous attention to detail.
Minimized errors by 40% and increased patient satisfaction ratings by 25%, streamlining the prescription refill process,
P.A. claims, copay assistance programs, and recovery process for patients.
Guaranteed seamless billing processes by verifying monthly insurance claims for refilled patients and processed new
insurance claims for new patients.
Grew patient retention rate by 15% and referrals by 25%, promoting specialty services to new patients.
IMAGE CUSTOMIZE AUTO SPA CORPORATION Chicago, IL
OFFICE ADMINISTRATIVE ASSISTANT May 2009 Oct 2017
Lowered customer inquiries by 40% while increasing customer loyalty by steering customer outreach initiatives and
delivering timely order confirmations and updates on order status.
Sustained efficient supply management by maintaining optimal inventory levels through regular stock checks and
accurate forecasting, and expediting orders for timely receipt and proper stocking.
Amplified productivity by instituting effective delivery system using personal vehicles, ensuring a smooth office schedule.
ARNOLD SCOTT HARRIS, P.C. Chicago, IL
LEGAL ADMINISTRATOR Aug 2015 Jan 2016
Earned commendation for ensuring accurate and timely processing of 300-500 filings monthly for the City of Chicago
to meet regulatory requirements and avoid penalties.
Diminished confusion and inquiries by 50%, educating clients on the recovery process, clarifying its hierarchical
structure, and empowering them to navigate it effectively.
Hit 98% success rate in case resolutions by managing dismissals, conversions, and discharges for bankruptcy cases,
ensuring compliance with court regulations.
Yielded 15% increase in overall profitability by producing detailed financial analyses, including revenue forecasts and
expense breakdowns.
BLITT & GAINES LAW OFFICES Wheeling, IL
LEGAL ASSISTANT Feb 2015 Jul 2015
Skyrocketed revenue by processing 500+ legal pleadings monthly, optimizing verification and maintenance
procedures to achieve a 98% accuracy rate.
Accomplished 95% success rate for debt recovery by executing bank and wage garnishments in cooperation with legal
counsel and cross-functional teams.
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Candidate's Name , CPhT, MBA
Chicago, Illinois | PHONE NUMBER AVAILABLE | EMAIL AVAILABLE | LinkedIn Profile
Pivotal in reducing case backlog by 50% and increasing overall efficiency by 30%, conducting comprehensive
investigation and analysis of the existing Pleading process in Missouri and Illinois.
ROBERT HALF EXECUTIVE SEARCH Chicago, IL: 2013 2015
LEGAL PROCESSING CLERK Jan 2015 Feb 2015
Automated data accessibility and retrieval by seamlessly integrating GX3-desktop management system, enhancing
document organization, and achieving 100% compliance with firm-wide document management protocols.
Eliminated data redundancy by 40% and improved data accuracy, leading database modifications and deleting
outdated entries.
Saved 15+ hours of manpower weekly by performing extensive research to develop and implement an efficient file
allocation and retrieval system.
Promptly submitted legal documents and minimized delays in closing processes by adhering to strict compliance of
100+ real estate transactions with government regulations.
LEGAL ASSISTANCE AUDIT SPECIALIST Apr 2013 Dec 2014
Enhanced organizational efficiency and client confidence by exhibiting keen eye for detail in locating and submitting
audit documents according to client checklists and directives, securing essential audit documents.
Mitigated risks by evaluating the effectiveness of various company systems, including Blacknight, LPS, DocuWare,
and Lenstar to ensure compliance with industry regulations.
Safeguarded project timelines and revenue targets by proactively assessing document gaps, devising a
comprehensive plan, and successfully obtaining critical missing documents.
ED UC ATI O N & C RED E NT IA L S
MASTER OF BUSINESS ADMINISTRATION (MBA) IN MANAGEMENT: MAR 2022
DePaul University - Charles H. Kellstadt Graduate School of Business Chicago, IL
BACHELOR OF ARTS (BA) IN CRIMINAL JUSTICE/SAFETY STUDIES: MAY 2012
Northeastern Illinois University Chicago, IL
National Society of Leadership and Success
ASSOCIATE OF ARTS IN LEGAL ASSISTANT/PARALEGAL: MAY 2009
Northwestern College Oak Lawn, IL
Alpha Beta Gamma
LEAN SIX SIGMA WHITE BELT CERTIFICATION: SEP 2019 PRESENT
Health Care Service Corporation Chicago, IL
NHA-CERTIFIED PHARMACY TECHNICIAN (NHA-CPHT): OCT 2026
National Healthcareer Association (NHA) Leawood, KS
NOTARY PUBLIC: SEP 2024
Illinois Secretary of State Springfield, IL
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