Reviewed, and updated Medicare Advantage Regulatory Policies, Procedures and Provider ManualsDeveloped systems, to optimize procedures and controls for utilization management reporting for member notificationsGovern the application of TRUST utilization management program for MA PPO Analyzed and reported Health Service Delivery (HSD) data, for hospital and axillary providersIdentify and documented patterns of care deficiencies within HSD tableSupported leadership in the evaluation, implementation and production of process work flows for Commercial and Medicare Advantage Account systems Provided data, and responded to RFI/RFP Association request for MA PPO businessConducted outreach to Provider Consulting Services to contact providers for possible contractingProvided Network Management attestations and evidence for National Health Reform, Compliance Liaison Counsel and QHP committees

Populate, analysis and reported the Health Service Delivery (HSD) table which included datafor hospital and non-hospital providers.Produced Patterns of Care documents to support deficiencies found in HSD table analysis.Produced professional, hospital and non-hospital provider availability study report.Produce list of deficient provider types and non-contracted providers in same specialty per county,then reach out to Provider Consulting Services to contact providers for possible contracting. Update Medicare Advantage Preferred Provider Organization (MA PPO) Marketing Tool. Assisted with updating the MA PPO online Provider Manual. Conducted market research with extensive experience in analysis of product benefits, value propositions, setting and analyzing price points. Preformed yearly review and updating of the MA PPO policies. Coordinate with MA PPO Compliance and Oversight for CMS audit efficiency. Participate in the National Health Reform, Compliance Liaison Counsel and QHP Process.Respond to RFI/RFP requests for MA PPO. Responsible for assisting and supporting management in the evaluation, recommendation, establishment, implementation and analysis of new and improved production work flows. Worked processes for systems reporting and new products / programs to improve customer service levels and overall quality. Performed variance analysis between actual and standard costs. Analyze, process and/or expedite operational transactions; including timely resolution of problems. Participate in systems testing, develop procedures / controls and provide recommendations for the ongoing improvement of the updated process. Provide leadership team with status of projects; issue, communicate and recommend policy decisions to achieve project objectives. Utilize and maintain available corporate production and reporting systems. Produce routine and non-routine reports, presentations, letter communications and graphics.

Support monthly verification process by confirming insurance eligibility through Michigan Medicaid web site “CHAMPS” and through Blue Cross Blue Shields/Medicare web sites “Web Denis” & “CONNEX”. Contact customers to confirm need for monthly Urological, Ostomy or Diabetic Supplies. Deactivate non-eligible client’s accounts and mail out not eligible letters. Update and document all account with any activity. Example: Communications, Confirmations and/or documents received. Release eligible and confirmed orders for shipping once Quality Assurance and Controls have been performed.

Analyze existing accounting and financial information and systems. Analyze monthly balance sheets, income statements, and changes in financial position/budget variance. Analyze accounts receivable and payables system. Work on bank reconciliation and compilations, financial statements, audits and audit reviews. Assist in the design and preparation of budgets for review by management. Monitor expenses to ensure compliance with budget by performing monthly variance analyses. Create and generate financial reports to determine or maintain records of assets, liabilities, profit and loss tax liability, or to the financial activities. Prepare financial statements and balance sheets.

Work with a team to support the delivery of 2007 expense budget of $1.8 Billion by consolidating several components of Marketing, Sales & Service and rolling up to Ford’s bottom line. Support several organizations in budget and forecast development, contingent liability reporting, business plans and financial objectives, managing opportunities and risks and internal control processes. Support monthly close process using accounting functions, entering accruals, journal entries, budget transfers and billings. Verifing financials are accurate representation of current state. Support Internal Control Foundation by performing and supporting internal audits. Support monthly close process of Ford Auto Buy Purchasing Card Program (also known as the FAB Card). Perform monthly and quarterly audits on individual "FAB" purchasing card owners. Approving submission of corporate meetings and events registration in compliance with company policies and procedures, and budgetary compliance.

Transactional and program purchasing for all Roush Facilities, Manufacturing, Industrial, Racing, Technologies, and Proto-TypesNegotiate pricing, terms, quotes, and contracts with over 2,000 vendors and suppliers both Nationally and InternationallyScheduled vendor visits to negotiate pricing, discuss new products and services and to establish a good work related rapport with sales personnelPrepared and presented proposals for service of hazardous waste disposal and chemical spillsPrepared monthly cost savings reportReconcile monthly procurement card bank statementPrepared and processed requisitions, purchase orders and inventory replenishment ordersAide the Accounts Payable Department in the processing of payment vouchers to the vendors by researching and resolving any invoicing discrepancies Assisted in the receiving of goods and services process, quantity received verses quantity orderedProcessed check request for Cash on Delivery orders

Job duties, responsibilities, and accomplishments are the same as for Roush Industries listed above. I first started working at Roush Industries as a Agency Employee through Populas Group Contracting Agency and was hired by Roush Industries as a full time employee.

Managed and maintained budgets for seven different GM automotive brands, such as; Saturn, Oldsmobile, Buick, Hummer, Chevy, GMC, and PontiacScheduled meetings with each budget planner to determine yearly and quarterly budgetary needsPrepared, reviewed and processed budgetary requirements and requestsAudit and reconciled fiscal accounting reports for both accuracy & completenessPrepared billing and accrual summaries for each budgetProvided "hands on" step by step training for new employees