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Yyyyyy x. yyyyyy
0000 xxxxxx xxxx , xxxx , xxxxx 00000 xxx-xxx-xxxx | abc@xyz.com
Profile of Qualifications
- 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.
Key Areas of Expertise
Leadership Quality Control GHI Market Prominence & Mainframe |
Process Improvement Regulatory Compliance QCare, OMT & eRPT |
Interpersonal Communication Training & Development MS Office Suite
|
Professional Synopsis
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.
Education & Professional Development
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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