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Healthcare Compliance Analyst Resume

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Lenexa, KS

SUMMARY:

  • Excellent at requirement gathering, taking business, financial & user data from shadowing, interviewing & brainstorming for functional, system, technical, etc. Thus providing meaningful analysis to drive business decisions while being proficient in critical thinking & adaptable to change with demonstrated track record of establishing priorities & meeting deadlines.
  • Organize, coordinate & manage resources throughout projects while managing & others, successfully working with complex organizations, and dependable Follow - up skills, with the ability to operate autonomously and deal with ambiguity.
  • Auditing, accounting, billing, invoicing, analytical research, cross-referencing information with complying with financial, legal & healthcare insurance institution compliance & regulations.
  • Strong organizational & time management skills, solid leadership skills & superb team player with great people skills relationship building skills, good sense of humor, excellent critical thinking problem solving ability with capacity to bring problems to resolution.
  • Highly organized, learnable, teachable & demonstrates excellent listening aptitude, superior oral articulation, professional demeanor & confidence while speaking, strong written communication skills; along with strong people/relationship skills with strong presentation & facilitation skills to communicate with & persuade a wide range of audiences.
  • Effectively collaborated with a diverse group of individuals across multiple levels & functions within the organization as well as external partners providing excellent customer service to clients, senior management, & other parties involved to create scenarios.

TECHNICAL SKILLS:

Skills/Programs: - Microsoft Office / Suite -MS Project -MS Word -MS Excel -Power Point -MS Access (queries) -Accurint / Lexis Nexus -FIS / Oracle / PAM -Fidelity / LPS -Salesforce / CRM -Provest / Tracker -AS400 (queries) -Google Docs -Technical Writing -Visio Drawing -Skip Tracing / Data Mining -Bloomberg -AON/SYNC/Benefit Focus -Tableau -Workday / ADP -Various Excel skills as pre-determined by financial intuitions parameters (i.e. modeling / functions) -Social media

Skills: Windows 2000/XP/Vista/7/8, Mac OSX, Microsoft Office, LAN/WAN, TCP/IP, DHCPNetworks, Routers, Switches, Hubs, Cabling, Norton, Antivirus protection, Printer/Scanner, Fax TroubleshootingPeripherals, Backup & Recovery, VPN’s Remote Desktop Support, PCAnywhere, e-mail systems, Calendars, browsersremote access, hard drive encryption, wireless networking, mobile device management, customer service, telephone skills, technical writing, asset management, product documentation, project management. This experience has came from 20 years of personal use & from all previous employment projects.

PROFESSIONAL EXPERIENCE:

Confidential, Lenexa, KS

Healthcare Compliance Analyst

Responsibilities:

  • Team up with compliance department, project managers & different teams to integrate business change management activities into the project plan for correct billing, invoicing, accounting & payroll.
  • Prepare multiple reports, ad hoc reports and standardized reports, run queries and audits to ensure complete data integrity.
  • Wrap up year-end projects & reports, manage multi day insurance projects from kickoff to completion keeping track of hours worked & progress of projects, provided support, analysis & auditing for various monitoring programs for the health corporate compliance department.
  • Cross-d data from multiple system applications to make sure information aligned with business requests & requirements.
  • Maintain & complete existing reports & develop new reports to support organizational business needs including utilization management & claims processing, investigates compliance, privacy, & information security.
  • Research & analyze unique requirements resulting from new clients, new products, or changes in insurance regulations.

Confidential, Kansas City, MO

Financial Supporting Analyst

Responsibilities:

  • Developed business process, analysis, accounting, business models, flows, storyboards, FAQs, user guides, & other technical specification documents for various applications & business areas.
  • Execute end-to-end functional tests and develop procedures, utilize automated systems developed by others to exercise system results, collaborate with others to achieve end-to-end product and process quality .
  • Partner with the project team, business representatives, & corporate communications to develop communication strategy & tactics, while participating in various workshops for integration projects & conducted business process review meetings.
  • Perform business requirements analyses based on feedback from clients during project kickoff calls, responsible for delivery & project implementation by taking visions & plans & turning them into reality for strong department infrastructure.
  • Lead project management, management & of 12 individuals through mentorship, video & audio conferencing & screen sharing. Manage projects with multiple trainees “Project Ocean”, KPI review performance & oversee tasks in a matrix management environment. Developed, implemented & maintained a compliance & program, to include conducting audits & systematic reviews & monitored compliance.
  • Compiled, examined & evaluated information, documentation & prepared findings to determine compliance with regulations & company policies & procedures. Presented audit findings to senior leadership or audit manager responsible for the official development of reports & performed testing of key controls & documented results for client signoff to make sure trades are fiscally allocated to correct accounting vales between $2 7,000,000.
  • Executed audit scope, objectives & work plans by performing prioritization, running data queries & data mining pulling actionable insight out of complex structured & unstructured data sources to aggregate data in large scale integrated financial systems, while managing the work queue, performing routine duties & audit data analysis for METLIFE mutual funds trades on insurance accounts, reconciling accounting values on (Journal Entries, Cash, Income, Purchase Sales, STAT, GAAP, SOP, NAV, General Ledger, Foreign Reclass, Futures), research variances & correct as required with minimal supervision with appropriate sense of urgency in highly accurate deadline time-sensitive situations.
  • Ensure timely preparation & distribution of daily, weekly, monthly, quarterly, semi-annual, KPI reports using internal data, data tables; prepare ad-hoc / reconciliation / financial projects reporting for managers & help with last minute requests.
  • Executed procedures supporting external audit of internal controls, business processes, & accounting balances for client specific deliverables; handle verification & communication of exceptions to ensure resolution.
  • Attended all relevant classes, work with team to refine, manage & lead process improvements, developed company compliance framework, optimize & develop standard operating procedures, working with the end users to create knowledge base content, define & document process enhancements through instructional design, become a subject matter expert in multiple systems & technologies, developed & maintained productive client & team relationships through individual contacts & group meetings along with strengthening audit & compliance functions creating infrastructure to train up a new department in India for successful end-users regarding systems functionality processes for department roll over.

Confidential, Overland Park, KS

Business Operations Reporting Analyst

Responsibilities:

  • Team up with HR to create and maintain objective goals with the intent to maximize the effectiveness of Workdays performance & proficiency, manage configurations from beginning to end including modifications to business process updates.
  • Help with text updates and system changes, fix Workday related issues by supporting HR technology projects or initiatives involving workday HCM’S, EIB spreadsheets and loading planning results.
  • Planned & coordinated with business stakeholders for business analysis, functional assessment, scoring, maintenance of requirements matrix, & integration related business process review.
  • Responsible for generating accurate procurement reporting for billing & invoicing, calculate commission checks for accounting, extracting actionable insight from large, diverse information sets through data mining executed audit scope, objectives, & work plans by collecting & analyzing information from various sources, database management, program calculations, new webpage roll out, contract life cycle management & updating Oracle database with supplier information; manage fuel supply for BP & Shell within the Kansas City market.
  • Supported internal business intelligence, metrics, reporting, & modeling of data tables from internal data to support audited aspects of EMV projects. This includes both operational & financial pieces of the project. Manage operational flow, collaborate with project teams, develop relationships, work with project sponsors, leadership, business units, key stakeholders & users to identify project scope & focus, develop or monitor project initiatives, implement project requirements, plans, processes, tools, assign, guide, monitor project life cycle & ensure project success with clear communication.
  • Deliver quality project solutions to business problems or issues within KPI defined budgets, resources & deadlines. Lead large programs that involved significant business change. Provided expert project guidance & support proactively through project completion. Provide tracking, reporting, presentation to management & users. Work with users to produce project charters, conceptual design documents.
  • Provide leadership, support relationships & manage project risks, scope changes & other non-standard events throughout the life of the project while cooperating & communicating with & managing external vendor agreements & tracking service levels, extensive data mining & reporting including data auditing, data aggregation, validation & reconciliation.
  • Contribute to the development & execution of a set of actionable & targeted change management plans, including communication plan, change impacts, & plan. Manage procurement & onboarding process. Partner with the business function to ensure organizational change management is integrated into projects, where applicable. Develop a knowledge base to help make positive business decisions related to those programs to increase earnings.
  • Developed company compliance framework, applied structured management approach & methodology to optimize ensure pre-defined project management processes & practices are followed. Drive simplification & improvement as necessary for the people side of change for business functions & provided leadership focus on all sides of change, business process improvement, systems & technology, job roles & organization structural changes. Identify potential people-side risks & anticipated points of resistance, & develop specific plans to mitigate or address the concerns. Effectively audited & analyzed score reports, & communicate pertinent information to the field.

Confidential, Overland Park, KS

Healthcare Insurance Benefit Billing Business Analyst

Responsibilities:

  • Audited insurance change information, calculated, generated new & previous plan benefit billing & invoicing for accounting using data tables from internal data, supported projects by auditing & evaluating the financial impact of decisions on company business & utilized the proprietary data systems Google Docs, manual billing conversion from AON to Benefit Focus applying data mining to extract & merge data systems, prioritize files among old to new submissions for completion while updating premium billing system databases, while establishing priorities & meeting deadlines.
  • Assist in billing analysis reports/variance reports, and resolve billing discrepancies by working with Pay groups, oncycle processing, offcycle processing retro processing and other billing objects.
  • Lead in the delivery of high-quality programs & solutions that meet business needs, relate detailed project design documents & task-level project plans to organize cross-functional teams, partner closely with other members of functional project teams to define business requirements.
  • Independently exercises judgment based on the evaluation of collected case data for the acceptance, modification, or rejection of group underwriting requests on risks then communicate findings to delegated underwriting authority.
  • Responsible for auditing files to ensure compliance & rate reviews & rate change proposals, analyzed & identified trends, provided feedback & constructive reports to reduce errors, improve claims process improvement & performance by reviewing, researching, investigating, & auditing claims with a structured, standardized approach to work, determining premium rates, developing benefit schedules & coverage amounts for various levels of health Insurance for dependents for accounting purposes.
  • Maintained strong working relationships with team key leaders & management to creatively answer business reporting & analysis needs to optimize the operations while assisting aspects of the underwriting process & due diligence including financial statements, current litigation trends & individual risk factors.
  • Generated workflow balance to ensure correct accounting of pre & post payment claims were moved timely to safe statuses, exports are updated, sent timely & accurately, & claims are not aging in the claims processing systems.
  • Provided well thought out solutions, & supplied fortified information to build audit reporting recommendations to lessen errors & enhance process conduct to successfully complete dispute files by updating spreadsheet, identified, completed, & organized insurance information, provide improvement ideas on developing infrastructure developed company compliance framework while streamlining processes.
  • Submitted files for supervisory review & approval all decisions based on the evaluation of collected case data, for acceptance, modification, or rejection of group underwriting requests on risks not within the delegated underwriting authority.

Confidential, Kansas City, Mo

Financial Auditing & Reporting Analyst

Responsibilities:

  • Managed Projects, lead ongoing enhancements, optimization & customization as well as set up automated audit reporting as requested, working closely with senior leadership & board members on both client & strategic partners defining new solutions or integrations with a focus on improving workflows / operational improvements using strong quantitative skills, developed company compliance framework, financial analytics & accounting with problem solving capabilities while prioritizing multiple responsibilities in a fast paced environment.
  • Participated in the review & creation of operational process & procedures for efficiency improvement; created & maintained all process documentation, presented audit findings to audit management for the development of reports in data table format, recommendations, presentations, & projects as requested.
  • Reviewed, audited, & monitored clients banking activity with distributed ledger technologies (DLT) & real time queues for various banking transactions performing data analysis for accounting from internal data using business intelligence & using enterprise research tools by analyzing banking deposits, withdrawals, transaction history & activity while meeting daily productivity deadlines.
  • Responsible for conducting investigations to objectively review & access compliance with applicable federal, state & local regulations & H&R Block policies & procedures. Responsible for independently leading & performing a wide variety of compliance related activities & investigations. Compile & analyze key compliance metrics, business area reports & audit results to identify & assist with compliance & fraud risk assessments & conducts audit investigative assignments.
  • Independently determined transaction trends; while independently recognizing potential litigation or reputation risk to avoid any significant negative accounting impact to the bank through executing fraud analytics while taking appropriate action for resolution approving or denying the case & crediting back clientele when justified per banking guidelines & parameters creating real-time payments that are immediately visible & creating organization transparency. Worked with the business areas to develop key oversight metrics to monitor compliance.
  • Maintained or exceed established service level agreements through auditing regarding state & federal statues guidelines such as, including Reg CC, Reg E, Bank Secrecy Act, US Patriot Act, Privacy, Uniform Commercial Code (UCC), FACTA, Gram Leach-Bliley (GLB) for timely resolution of transactions to minimize potential losses & to determine levels of risk & transaction type.
  • Applied banking interoperability to distribute data, record keeping, accounting & reconciliation across separate client financial accounts, resolved complex issues with little or no supervision, & develop positive working relationships with peers & seniors.
  • Work with business, finance, & operations teams to create unified data models in support of business initiatives & projects, audited, analyzed & prepared financial dashboards & or executive summaries highlighting key financial results, responsible for fraud analysis, reporting & support in a variety of bankcard security systems across the consumer card, debit card & commercial card lines of business, perform monthly fraud reporting, pull compliance audit data, & work closely with investigators to identify & analyze fraud patterns & communicate these within the department & to the lines of business.

Confidential, Erie, Pa

Client Relations Manager

Responsibilities:

  • Generated & managed sales for a direct marketing company producing 30 - 50 calls daily by being an independent & solid team member, while developing relationships, & providing excellent sales experience to increase customer satisfaction & repeat sales.
  • Guided client through the purchasing process & options, while up selling & cross-selling products & services, to benefit the company & customer, increase value, & exceed customer expectations.
  • Possess & cultivate strong critical thinking & solutions-based outcomes, provided customers with solutions in challenging situations, sales &/or fulfillment requests by resolving issues with their order delivery status, pricing, personal account discrepancies, or many other possible variables using clear communication.
  • Calmed down irritated customers, solve problems, investigate issues, & requests that include gathering additional information, setting positive expectations, while working in a dynamic, fast-paced environment & handle multiple projects / change requests.
  • Consistently a top producer that achieved & surpassed various monthly sales goals by up to 22%.

Confidential, Pittsburgh, Pa

Mortgage Compliance Auditor

Responsibilities:

  • Audited & Performed due diligence (DD) on Confidential / Countrywide (FHLMC / Freddie Mac, FNMA / Confidential guidelines) residential home loan applications identifying, investigating & verifying mortgage information for potential fraud through (KYC) know your customer, that the given information is complete & meets banking & governmental regulations, including type & amount of mortgage, calculating the value of the borrower's collateral, assets, income, debts, liabilities, credit history, & employment through (QC) quality control.
  • Identified misrepresentations, used independent thought through auditing variables, performed analysis & properly cataloged findings into a concise effective written summary that composed logical, grammatically correct reports through (CSA) control self assessment policies, loan-to-value (LTV), debt-to-income (DTI) ratios, possible (AML) Anti-money laundering, along with reviewing & approving completed (SAR’s) suspicious activity reports. These reports are used to report fraudulent/suspicious activity to the Department of Treasury Financial Crimes Enforcement Network.
  • Made recommendations for process improvements & or corrective action measures by developing process procedures.
  • Developed & maintained strong working relationships with audit managers, senior leadership & team members, provided great customer service with appropriate industry groups, & governmental agencies, other employees, business channels/sales, legal, borrowers, lenders, & vendors to communicate & discuss the results of investigations, & recommendations related to early payment defaults, claims, & coverage.
  • Analyzed elements of pre & post closing file review through auditing compliance, identifying instances of lender non-compliance, or other relevant guidelines, possible misrepresentation, data integrity issues, the differences between file information versus data submitted, or layered risks that result in an inappropriate risk profile for the loan.
  • Research, analyze, validate & gather data to assess the effectiveness of internal controls to mitigate compliance risks, Make recommendations for process improvements & corrective action measures, compiled examined & evaluated information & documentation & prepared findings to determine compliance with regulations & company policies & procedures.

Confidential, Tampa Bay, Fl

Project Manager - Legal Compliance

Responsibilities:

  • Accountable for overall project management & leadership, including planning, day-to-day management, quality assurance & communication through various KPI’s. This includes completion of established tools & execution of processes needed to manage projects to conclusion. Organized, monitored, coordinated, delegated, audited, reported, managed projects & workflow for a real estate law firm; managed 80 to 100+ files daily supervising 10+ employees & utilizing matrix management skills & ability to oversee tasks delegated to others. Leveraged the workflow & volume pipeline, met deadlines, ensured goals & objectives are accomplished within prescribed time frames & parameters, developed company compliance framework while supporting various client needs with little or no supervision. Worked specifically on e-discovery related activities.
  • Established projects are managed in a rigorous manner to drive accountability & the high quality. Participated in a planning process for each project, designed to correctly identify the scope of the project, & to staff, train, & manage the project appropriately within that scope.
  • Serviced, received, researched, processed, resolved & followed up on any (POC) points of contact such as clients, vendors, partners, defendants, attorneys, subordinates or other interested parties while building, establishing, & maintaining good relationships & communication, manage expectations, produced productive results in a timely & professional manner with planning & execution of various legal process outsourcing projects, & to partner with the delivery team to successfully deliver projects, manage vendor agreements and track service levels.
  • Ensured that all issues are escalated in a timely fashion to senior leadership & will ensure that all reporting & scorecards are completed as needed. Driving excellent communication & relationships internally & externally while being accountable for internal & external communication for each project ensuring that daily & weekly progress of product production & quality are reported.
  • Audited legal documents through data mining, examined copies of records, such as mortgages, liens, judgments, easements, vital statistics, & plat & map books, & public records to determine ownership, legal restrictions & to verify legal condition of property.
  • Managed & directed the activities & people associated with small to large scale projects with a focus on experience with litigation document review & part of a team that focuses on the legal review who processed foreclosure files from service to post sale, prepared required legal pleadings, & ensure foreclosure-tracking system in client proprietary database system & data tables are updated properly along with state, judge, client & company guidelines for compliance.
  • Worked a 40+ hour per week with little to no advance notice including evenings, weekends & holidays due to fluctuating stressful heavy work volume to meet law firm & client deadlines within a team environment.

Confidential, Tampa Bay, Fl

System Installation Project Manager / Technician

Responsibilities:

  • Successfully managed a team of 5+ Technicians while offering leadership as well as high-level professional & analytical expertise to projects. Planning, executing & closing daily projects either on time or ahead of schedule.
  • Set up 500+ brand new Windows OS based computers for employee use consisting of laptops & desktops within Confidential corporate centers & retail banks; Installing, maintaining & diagnosing issues, PC Hardware & software updates, networking, printers, & related peripheral equipment to ensure optimum performance & reliability.
  • Effectively used technical troubleshooting skills used to rapidly resolve challenging technical hardware & software issues.
  • Removal of previous computer systems; complete wipe / deletion of previous hard drives, following design or uninstallation specifications. Enter commands & observe system functioning to verify correct operations & detect errors.
  • Correctly networked each computer into their corresponding patch bay RJ45 port for access & communication with the district server.
  • Properly arranged, neatly organized & secured vast amounts of power cords & CAT5 cabling.

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