Ambitious healthcare compliance Program Manager with solid history of success in project and program management operations. Motivated to drive productivity and efficiency goals through proactive and hands-on partnership. Offering 8.5 years of related experience and pursuing new professional challenges with room for advancement at _____.
Skills
Project management
Facilitating audits
Reporting requirements
Interdepartmental relationships
Attention to detail
Work ethic
Analytical problem-solving
Project presentation
Articulate, verbal and written
Team building
Friendly, positive attitude
Microsoft Office (Visio, Excel, Word, PowerPoint, Outlook, Teams);
SharePoint; Nitro Pro
Experience
Program Manager, Compliance, 04/2019 - Current Google Inc. – Miami, FL,
Managed annual external Medicare audit. Collaborated with external partners and internal functional areas to complete audit milestones. Coordinated with staff to enforce audit procedures resulting in problem solving and smooth operations. Identified, addressed and either resolved or escalated project issues.
Oversaw MMP data submissions for CMS required reporting on a quarterly and annual basis. Verified accuracy of data with CMS reporting technical specifications. Consulted with internal functional areas and key stakeholders to share best practices and process improvement tools.
Contributed to the ongoing implementation of the enterprise-wide Key Performance Indicator (KPI) process for routine monitoring and identification of compliance risks. Conducted review of KPIs by functional area for all Molina Health Plans and all lines of business; Medicare, Medicare-Medicaid Plans (MMP), Medicaid and Marketplace.
Developed and implemented action plans with established timelines and milestones, assigned tasks to appropriate teams, managed workflow and met deadlines on or before schedule. Designed and managed project SharePoint sites.
Led cross-functional high-visible projects with minimal guidance. Developed robust training materials to increase awareness of project requirements. Helped staff improve productivity and efficiency though one-on-one coaching in order to achieve project objectives.
Managed annual external Medicare and MMP audits concurrently. Coordinated with external audit teams and internal functional areas to complete audits. Performed quality assurance on high-volume deliverables on or before schedule. Presented audit results to management teams.
Oversaw Medicare and MMP data submissions for CMS required reporting. Developed a full understanding of reporting technical specifications to ensure the organization’s compliance with State and Federal requirements.
Investigated cases of HIPAA violations and FWA allegations involving Molina members and providers. Conducted phone interviews with internal staff, members, and providers. Developed initial risk assessment based on investigative findings. Identified root cause and potential impact to the organization.
Led multiple cross-functional projects concurrently. Established training materials and facilitated meetings that required participation from internal teams and senior leaders.
Built effective working relationships with external partners and internal functional areas including Pharmacy, Health Care Services, Claims, Appeals & Grievances, Delegation Oversight, Medicare Administration, and Medical Informatics.
Managed external Medicaid audits. Worked with external and internal teams to ensure audit requirements were met. Developed audit summaries for Senior Leadership Teams to address findings involving potential beneficiary or financial impact to the organization.
Developed audit tools to conduct quarterly internal audits of Appeals and Grievances. Collected universe and selected samples for in-depth file review. Provided audit reports and risk analysis based on audit results.
Investigated cases of HIPAA violations and FWA allegations. Collected supporting documentation to substantiate violations and allegations.
Processed member requests for access to PHI and Power of Attorney. Ensured compliance with HIPAA privacy and security laws. Developed and implemented HIPAA and FWA training materials.
Analyzed State OIG Exclusion Lists and Sanctioned/Terminated Provider Lists. Determined potential impact and risk to the organization. Collaborated with appropriate operational teams to evaluate findings. Provided timely notifications per State contractual requirements.
Coordinator, Compliance, 07/2012 - 02/2013 Molina Healthcare Of California – City, STATE,
Scheduled meetings for the Compliance Director, submitted monthly financial reports, and managed department budget.
Compiled Board Reports for the Health Plan President and Leadership Teams. Developed Power Point presentations and took meeting minutes for quarterly committee meetings.
Tracked the completion of required Compliance, FWA and HIPAA training for new employees. Coordinated with new employees to ensure timely completion. Served as project manager to lead the organization’s Compliance and FWA Week.
Education
Bachelor of Science: Business Administration, Expected in 08/2012 - California State University Dominguez Hills - Carson, CA, GPA:
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