- Ownership and Development of Medicare Issue Remediation System (MIRS) a centralized platform to remediate Medicare compliance-related issues.- Responsible for reinforcing and sustaining MIRS tool ongoing operations. Project Managing enhancements, development, analytics, access and administrative ServiceNow requests, driving IT and business/compliance meetings, user acceptance testing, onboarding new groups, developing dashboards, leading information sessions, group/user updates, pre and post go-live communication.- Accountable for planning, organizing and controlling performance to achieve the execution of programs strategy, analyze complex situations, ongoing development, communication, onboarding, training, process development, performance opportunities and monitoring.- Facilitated CAP Committee, a cross-functional Committee with Business and Compliance representation responsible for reviewing CAP proposals and confirming remediation and validation plans are adequate.- Worked with Compliance and business partners to identify issue management process improvements and system enhancements.- Data Measurement Reporting and monitoring metrics, targets and performance, ongoing training/learning support, granting access, building dashboards, interactive filters, performance analytics, workbenches, and targets specific to tool usage and quality performance.

- The Medicare Part D/ Medicaid Rx Legal Compliance Lead Analyst for Clinical Programs Compliance Department.- Ownership of ESI Implementation Project- tracking, reviewing and escalating compliance concerns tied to 1/1/2020 integration of Express Scripts as the new PBM.- Facilitated Medicare Part D-Medicaid RX Issue Log for Compliance Partners & Business Areas, gathering and providing communication regarding issues, gaps and findings to the Compliance Leadership Team. - Conducted Online Formulary monitoring and MTM monitoring focusing on MAPD and PDP targeted beneficiaries. - Accountable for corrective action plan (CAP) management, FDR oversight, internal audits and reporting metrics.

- The Medicare/ Medicaid Regulatory Operations Specialist for First-Tier, Downstream, and Related Entities (FDRs) that service over 400K Medicare Advantage members across the entire Cigna-HealthSpring footprint. - Conduct monitoring of FDR delegated functions such as billing, case management, claims, contracting, credentialing, customer service, enrollment, and utilization management.- Assess FDR's ability to perform and manage in accordance with regulatory and business standards.- Responsible for gathering and providing communication regarding findings/gaps/ solutions to leaders team via verbal or written summary/ presentation. - Maintain proper documentation of FDR data for monitoring and remediation efforts and assist management with internal and external audits.

Participating in a 12-month general management rotational program for Cigna's senior segment designed to allow associates the opportunity to work on relevant, impactful projects; build relationships across departments; meet regularly with senior management; and develop key presentation skills. Completed project work in Stars, Operating Effectiveness, Customer & Client Service Experience , and National Health ServicesMajor Accomplishments:-Rotated through key departments within Cigna-HealthSpring as an embedded consultant on projects to aid in strategic development, operations and implementations.-Evaluated the Alabama market processes for inpatient discharges and followed up specific to Medication Reconciliation Post-Discharge. Identified process gaps and executed best practices to yield higher Medication Reconciliation Post-Discharge rates.-Collaborated with change managers in delivering effective change management reinforcement/adoption strategy. Build something tangible a communication plan for deployment, in order to improve people, process and to move from crisis to sustainability.-Build integration processes between SNP team and clinical program vendors. Partner with sourcing team to document and build processes to aid the national health services and ensure that all the processes are documented and implemented in a seamless fashion.

- Managed/supervised transportation company 100+ employees in a Tri-State area running 150+ Busses/Ambulances. - Planned, organized, and directed the accounting and finance functions of the company; reporting of all financial statements, tax-related statements, and operational functions.- Established goals, objectives, and strategies for employees in compliance with HIPAA policies and other regulatory laws.- Reviewed and organized medical reports for discharged, outpatient, and inpatient emergency cases. - Ensured that all Medical QA, Annual Training and Education related materials met the criteria for the CAAS accreditation.

- Planned, organized, and directed the accounting and finance functions of the company; reporting of all financial statements, tax-related statements, and operational functions.- Established goals, objective, and strategies for employees in compliance with HIPAA policies and other regulatory laws.- Reviewed and organized medical reports for discharged, outpatient, and inpatient emergency cases. - Ensured that all Medical QA, Annual Training and Education related materials meet the criteria for the CAAS accreditation.

- Determined the right course of action after evaluating patient's condition/medical history in different scenario emergency cases.- Communicated with Base Station Hospitals and other receiving facilities to receive medical direction and provided critical patient care information.- Assessed patients in all kind of Basic Life Support cases and assessments.- Prepared patient care reports on each patient using different software’s which detailed patient history and diagnosis.