Ana Sofia Morales Email & Phone Number

Greater Minneapolis-St. Paul Area

Minnesota

Resolve specific reporting problems on an ad-hoc basis.Support data validation processes to ensure compliance with CMS reporting requirements.Monitor compliance risk areas for ongoing compliance with requirements and the reporting of issues to management.Conduct mock audits of internal processes and operations.Analyze results of mock audits to identify potential compliance deficiencies or trends.Develop, implement and track corrective action plans for identified compliance deficiencies.Analyze and monitor regulatory audit requirements on an ongoing basis for changes or additions Work effectively with staff from other functional areas inside and outside of CHA, including Finance and Internal Audit staff. Provide direction and compliance support to help functional areas prepare and plan for audits.

Minneapolis, Mn

Present written and oral arguments regarding Medica’s benefit determinations for Minnesota Department of Human Services (DHS) hearings.Investigate and respond to complaints and appeals received by Medica’s Medicaid, MinnesotaCare and Medicare members. Accurately report complaints and appeals data to DHS according to contractual reporting requirements.Create and distribute monthly reports regarding Medicaid complaints and appeals totals, trends and data analysis conclusions.Research and respond to regulatory inquires from the Attorney General’s office, the Minnesota Department of Health (MDH), and the Better Business Bureau.