Doris Moore Email & Phone Number

Minneapolis, Minnesota, United States

Santa Clara County, California, United States

Medicare Marketing Material Reviewer- May 2016- Current Review eligible Medicare Marketing/Communication Material, to ensure that all contents adhere to the relevant CMS guidance prior to submission or usage within the market place for year round or the Annual Enrollment Period(AEP). This could include materials used internally or for partners such as emails, direct mailers, websites, videos and google message. Adhering to established policies and best practices outlined by the Compliance Department. Consulted with Internal Legal to ensure risk is reduced for the organization. Medicare Complaints inquiry Reviewer- July 2013-May 2016 Provide Compliance Oversight to Sales Brokerage to correct non-compliant sales activities. Review and investigate compliance inquiries (Internal, External and CMS CTMs). Recommend the appropriate disciplinary actions for non-compliant findings. Build and maintain solid business relationships with individuals on all levels.

Cypress, Ca

Collaborate daily with other Internal Functional Teams to resolve issues related to Part D Prescription Drug Coverage. Interpreting Regulatory requirements, processes and guidance issued by CMS. • Serves as a Regulatory Affairs Consultant researching/providing clarification on CMS rules as raised by clinical functional teams• Research inquiries from CMS, ability to direct to appropriate team for resolution. • Identify opportunities for process improvement to Management/Business partners.• Maintain the Daily Communication Log-Between CMS• Tracking of the Notices of Non-Compliance• Assistance in the monitoring and tracking of compliance with the Reporting Requirements. • Maintenance of policies and procedures (Annual updating and the creation of new P&Ps as required to manage the workflow). • Internal Clinical Ops breaks/fix issues (formulary, etc.). Optum/ Project Manager- • Reporting weekly and overall audit reports to clients • Submitting best medical record to CMS for review for payment integrity and accuracy for risk adjustment payment• Identified opportunities for improvements with coding inaccuracies and other administrative training for Providers• Develop and maintains workflow processesPacifiCare- Medical Management Team Supervisor- Responsibilities include monitoring workflows, handling escalated calls, and reviewing telephone states and quality audits. Accountable for Annual Evaluations and counseling of employees. Interact with all levels of Management.

Project Management

Bachelor Of Arts - Ba, Organizational Leadership