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- Results-oriented Professional possessing excellent leadership, quality assurance and organizational abilities.
- In-depth knowledge of Medicare Part B and Part D.
- Regarded for ability to spearhead existing processes and implement successful strategies to increase efficiency throughout day to day operations.
- Top notch interpersonal skills, key to forming positive relationships with third parties and team members.
GHI Market Prominence & Mainframe
QCare, OMT & eRPT
Training & Development
MS Office Suite
Cognizant Technology Solutions (Formerly Emblem Health) 2009-2016
Quality & Compliance Specialist
- Utilized in depth knowledge of Medicare Part D, coupled with strong organizational skills and attention to detail, to perform assigned tasks on time in a fast-paced environment.
- Ensured compliance to all policies, internal controls and SOX regulations.
- Responsibilities included conducting in depth data analysis, maintaining quality control and case management.
- Thoroughly verified files updated in GHI Mainframe, GHI Market Prominence, Softheon and QCare.
Emblem Health (Formerly Group Health Incorporated) 2002-2008
Provider Enrollment Manager
- Fulfilled key leadership position, overseeing daily operations within enrollment department.
- Leveraged strong organizational skills to oversee preparation, credentialing, processing and maintenance of healthcare providers for enrollment in Medicare Part B.
- Streamlined existing processes by contributing to creation of internal tracking system; identified inefficiencies and developed effective strategies to increase performance.
- Developed and implemented successful training initiatives to increase employee performance and provide updates in regard to policies.
- Demonstrated excellent communication skills throughout provider interactions and inquiry resolution.
- Ensured adherence to all policies and regulations, critical to maintaining eligibility.
- Effectively communicated all changes or updates to staff to ensure critical compliance with standards; included efficiently updating internal control documents.
Group Health Incorporated 1997-2002
Benefit Integrity Manager
- Oversaw daily operations, with associated duties including maintaining quality control and participating in discussions with CMS, OIG, FBI and other Medicare contractors.
- Developed and implemented effective training initiatives for staff members; presented information regarding Medicare Part B in multiple seminars.
- Properly handled fraud complaints; conducted investigations, data analysis and testimonies as necessary.
Computers in Business Continuing Education, York College
High School Diploma, Springfield Gardens High School,
CMS Provider Enrollment and OIG Presentation Training
CMS Investigative and Data Analysis Training
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