SUMMARY:

• To work for an organization that will allow me to utilize my leadership abilities, contract management and health care experience.
• High - quality customer service
• Strong written and oral communications
• Skilled in building productive relationships with staff, management, and external contacts
• Fourteen years of health insurance experience
• Financial management and budget oversight
• Successfully interpret contract requirements and enforce compliance

TECHNICAL SKILLS:

Proficient: Microsoft Office, PROS, CHAS, FMMIS, FLORIDA, HealthTrack, SharePoint and Lotus Approach

PROFESSIONAL EXPERIENCE:

Government Analyst

Confidential

Responsibilities:

• Act as the Division’s primary contact with the Agency for Healthcare Administration
• Facilitator and non-voting member for the CMS Governing Body.
• Core member of the plan’s accreditation team.
• Coordinate all aspects of communication between the Confidential and CMS.
• Provide technical assistance to internal staff and the agency regarding reporting requirements.
• Interpret contract requirements and amendments and keep up to date knowledge of Florida Statutes and Legislation regarding managed care.
• Conduct performance audits on the CMS’s vendors to ensure compliance with contract standards.

Government Analyst

Confidential

Responsibilities:

• Prepare a variety of contracts and provide contract management oversight and consultation in all administrative areas including, but not limited to, contract development, budget management, invoice processing, administrative and programmatic monitoring, and financial reporting.
• Coordinate programmatic activities with appropriate program specific staff.
• Provide technical assistance to contract providers and CMS area offices concerning CMS Network contract implementation and coordination issues.
• Participate in quality assurance reviews to determine compliance with administrative and financial management requirements
• Prepare reports and make recommendations as necessary to correct identified deficiencies and improve operations and service delivery.

Medical Healthcare Program Analyst

Confidential, Tallahassee, FL

Responsibilities:

• Responsible for contractual and procurement related functions related to performance monitoring and oversight of the Health Maintenance Organizations (HMOs), Provider Service Networks (PSNs), and Prepaid Dental Health Plans (PDHPs), which includes:
• Contract monitoring of United Healthcare Community Plan and Positive Healthcare Medicaid medical plans for the State of Florida.
• Collaborate with health plan enrollees and providers to resolve any service issues and provide contractual technical assistance to the Health Plans.
• Conduct yearly on - site visits of each Health Plan, as well as regular desk reviews to ensure contract compliance and network adequacy.
• Coordinate regulatory oversight with other state and federal agencies
• Participate in Medicaid Fair Hearings as needed.
• Review, edit, and approve all provider and member materials related to health care delivery.

Government Operations Consultant

Confidential, Tallahassee, FL

Responsibilities:

• Monitor two enrollment broker contracts: Reform Choice Counseling/Enhanced Benefits and Medicaid Options (Non-Reform) and the Enhanced Benefit Program.
• Provide contract management oversight and consultation in all administrative areas including, system development, development, administrative and programmatic monitoring, and operational reporting.
• Participate in quality assurance reviews to determine compliance with administrative and operational requirements.
• Prepare reports and make recommendations to correct identified deficiencies to improve operations and service delivery.
• Develop statewide Medicaid Managed Care Long Term Care for the Enrollment Broker.

Quality Assurance Analyst

Confidential, Tallahassee, Florida

Responsibilities:

• Global technology services provider delivering business solutions to its clients. As a subsidiary of HP, the combinations of the companies represent a $20+ billion technology services leader. As the Quality Assurance Analyst, responsibilities included:
• Conduct process audits and progress checks independently of the project organization.
• Monitored seven (7) call centers for accuracy to ensure Service Level Agreements (SLA) were met.
• Collaborate with Florida Medicaid Contract Management staff on a regular basis to determine needs based on review of findings.
• Participate in Work Product Reviews and tracking corrective action plans resulting from the reviews.
• Perform process audits and maintaining project Quality Assurance records.

Document Control Supervisor HR

Confidential, Tallahassee, Florida

Responsibilities:

• As a leading provider of services to the health and human services industry, Confidential helps organizations reach out to the people served; qualify them for essential services; and manage their cases with precision, speed, and superior customer service. As the Document Control Supervisor HR Contact, responsibilities included:
• Develop Document Control Unit policies and procedures.
• Identify efficiencies in quality scanning and data entry methods to reduce error rating
• Manage ongoing operations of forty - two (42) employees, including Human Resources related issues.
• Monitor receipts of applications, ensuring archiving standards were met.
• Participate in quality assurance reviews to determine compliance with administrative and financial management requirements.

Eligibility Review Liaison

Confidential, Tallahassee, Florida

Responsibilities:

• Act as a liaison for the CMSN and MediKids program offices providing information regarding eligibility review and conducting monthly cooperative meetings.

Call Center Representative

Confidential, Tallahassee, Florida

Responsibilities:

• Provide accurate account information to Florida KidCare program participants.
• Perform quality customer service to members of the community.
• Efficiently execute State policies and procedures for Florida KidCare Program, as it relates to health insurance.
• Demonstrate comprehensive knowledge of the electronic records system containing member account information, while discreetly using data to perform job responsibility.