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compliance consultant resume example with 20+ years of experience

Jessica Claire
  • , , 609 Johnson Ave., 49204, Tulsa, OK 100 Montgomery St. 10th Floor
  • Home: (555) 432-1000
  • Cell:
  • resumesample@example.com
Summary

Results driven, analytical thinker seeking a position as a Senior Compliance Consultant. I have a proven ability to prioritize and complete multiple tasks with an emphasis on accuracy and attention to detail. I am experienced in, planning, coordinating, providing support on complex case handling, assessing problems, and developing solutions.

Skills
  • Records management expert
  • Customer service
  • Planning and coordination, project management
  • Communicates effectively with internal and external partners, as well as demonstrated strong presentation skills
  • Multi-tasker, results oriented, and self motivated
  • Strong analytical and critical thinking skills with the ability to identify, communicate, and address potential issues
  • Works independently and collaboratively with peers in self-managed teams
  • Works effectively in an Labor Management Partnership (LMP) environment
Experience
Compliance Consultant, 04/2017 to Current
Cvs HealthOld Saybrook, CT,
  • Collaborate with team members, internal and external stakeholders to ensure root cause issues are identified, corrective action plans are implemented, and issues are managed.
  • Performed investigations utilizing various compliance tools, databases and software applications.
  • Provided input for substantiated allegations to ensure corrective action plans meet compliance guidelines.
  • Participated in the Standardization of Compliance Investigations (SOCI) Member Services Work Group.
  • Monitored compliance adherence and prepared reports on compliance efforts, and programs as needed for internal and external audits.
  • Participated in conducting compliance and ethics training. (pre-pandemic)
  • Working knowledge of health care compliance policies, programs, practices, systems, and related compliance issue.
  • Through training and attendance of seminars related to investigations, privacy and security, fraud waste and abuse, conflict of interest, I gained knowledge of health care industry practices and standards including both federal, state regulations and accreditation standards.
  • I am a benefit specialist which is an essential aspect of identifying member types that may result in reporting to specific state and federal regulators.
  • I was the point person for all Member Services cases related to the Sacramento area due to my extensive knowledge of their case processing, in addition to my training with the CIWRS and METRS systems.
  • Collaborated with Regional Compliance Team to mitigate vendor management contract status.
  • Participated in investigatory meetings involving employees with Labor Management Partnership (LMP) representation.
  • Prioritized multiple long and short-term tasks with proven experience managing multiple conflicting priorities
  • Maintained an active presence by volunteering at local Kaiser Permanente sponsored events.
  • Maintained above satisfaction rating individually for case investigations and closures.
  • Supported the overall Compliance team objectives e.g. metrics, annual goals etc.
Senior Case Manager, 02/2001 to 04/2017
Principia Biopharma Inc.Los Angeles, CA,
  • Participated in case conferences with multi-disciplinary team to discuss client care planning and progression.
  • Responsible for timely case resolution and compliance with Federal and State regulations, laws and accreditation standards.
  • Responsible for effectively managing high volume case loads while remaining within compliance and continue to comply with regulatory mandated guidelines.
  • Highly proficient in the grievance and appeals process within a healthcare environment.
  • Competent working knowledge of Kaiser Permanente’s various health plans / benefits / contracts and database systems.
  • Experience with resolving complex health care issues/concerns by utilizing all resources available.
  • Protected patient data in alignment with HIPAA privacy protocols.
  • Facilitated ongoing case management services to support successful outcomes and meet stabilization goals.
  • Collaborated with various healthcare providers to facilitate delivery of services.
  • Advocated for members and families to coordinate care and navigate resources within the Kaiser Permanente network.
Recruitment Assistant /Administrative Assistant, 12/1999 to 11/2000
Kaiser PermanenteCity, STATE,
  • Maintained employee benefits programs and informed employees of benefits by studying and assessing benefit needs and trends.
  • Organize and facilitate new hire sessions for the Northeast Bay Service Area.
  • Created agendas and recording minutes for monthly staff meetings.
  • Responsible for creating flow charts and various documents using various software programs.
  • Created and distributed confidential departmental files to appropriate managers within the Northeast Bay Area.
  • Responsible for ordering and tracking office supplies.
  • Screened and directed all incoming calls using a multi-line phone system.
Education and Training
Associate of Science: Business Administration And Management, Expected in
University of Phoenix - Tempe, AZ
GPA:
Bachelor of Science: Project Management, Expected in 08/2014
University of Phoenix - Tempe, AZ
GPA:

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Resume Overview

School Attended

  • University of Phoenix
  • University of Phoenix

Job Titles Held:

  • Compliance Consultant
  • Senior Case Manager
  • Recruitment Assistant /Administrative Assistant

Degrees

  • Associate of Science
  • Bachelor of Science

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