Dedicated Compliance Specialist with expertise in Policy, Procedure and Quality Assurance

eager to contribute to the success of a progressive organization.

 

 

         Considerable strengths in project planning and coordination with solid knowledge of project management processes, methodologies and SDLC (software development life cycle).

         Excellent legal acumen, highly incisive and versatile, and able to quickly master new roles, responsibilities, software and environments.

         Proven ability to interface with all levels of management, peers, clients and specialists.   

         Proficiency in personnel training and education, policy and procedure development, and creating and executing measurable process improvements.

         Methodical problem solver with steadfast commitment to first-rate client satisfaction.

         Able to motivate teams, resolve conflicts, and steer personnel to achieve productivity excellence. 

 

 

WellCare Health Plans, Inc., Tampa, FL, 2008 to Present

Corporate Compliance Specialist C Policy and Training

         Spearhead comprehensive compliance program inclusive of training and education regarding laws and regulations affecting company operations.

         Develop and implement communication plans and strategies to inform staff of system go-lives, training roll-outs, and other initiatives.

         Explore, identify, assess and respond to potential areas of compliance vulnerability and risk.

         Play an integral role in revising, updating and improving corporate policies and procedures to continually fortify regulatory compliance.

         Contributed to major overhaul of company s compliance training program and introduction of  enterprise-wide compliance management system.

 

Schaller Anderson of TN (currently Aetna), Nashville, TN, 2004 to 2007 

Compliance & Communications Specialist       (2006 to 2007)

         Applied exemplary planning and organizational skills toward devising communication and training strategies to enforce compliance regarding health care regulations, policies and procedures.

         Diligently monitored and tracked monthly activity by all departments to ensure stringent adherence to  contractual obligations.

         Prepared and disseminated quarterly newsletter and monthly report for client featuring appeals statistics, operational enhancements, project milestones, staffing changes, etc.

         Analyzed quality audit findings and subsequent corrective action plans to ensure compliance with quality requirements.

         Proactively served on Policy/Procedures Committee, Performance/Process Improvement Committee, client s operating committee, and RFP Steering Committee.

 

Continued

 

 

 

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Project Management Consultant C Healthcare Informatics        (2004 to 2005)

• Proficiently directed IT project development from initial stages through to timely completion, clearly defining project scope, goals and deliverables to precisely align with business goals.
• Generated formal software implementation project plans, identified essential resources, and exercised strong leadership talents to delegate tasks to project team members.
• Held frequent progress meetings to advance efforts, maximize team cohesiveness and provide management, stakeholders and project development team with status updates.

 

Carolina Legal Associates/Motley Rice, Mt. Pleasant, SC, 2003

Litigation Paralegal

• Communicated with health care professionals, claims administrators, and legal professionals regarding claim status updates and settlement process.
• Exhibited sharp attention to accuracy and efficiency in preparing broad-scope legal documentation and correspondence, reviewing and processing claim forms, and drafting memorandum.

 

Schaller Anderson of TN, Nashville, TN, 2001 to 2002

Quality Oversight Coordinator          (2002)

• Contributed outstanding project management expertise toward developing program scope, work plan, and operating procedures for Quality Oversight Unit while implementing strategies for process improvements.
• Researched and determined benchmarks and performance goals indicated by federal healthcare regulation entities, vital to meeting all quality-related requirements.
• Analyzed quality audit findings of state-contracted managed care companies to determine best practices for client s program.

 

Medical Committee Liaison          (2001)

• Orchestrated recruiting efforts for physicians and other health care professionals to serve on committees within program.
• Organized committee meetings and seminars, recorded minutes, prepared executive summaries and maintained project tracking log.

 

 

Bachelor of Science in Sociology, College of Charleston, Charleston, SC, 2001