Georgia Richards Email & Phone Number

Speciaizing in:- Creating Data Dictionariews- Workflow Documentation- Market Research- White Papers- Data and Process Organization

Worked directly with the President and CEO fo Cembrus Capital to create:- Human Resources Documentation - Detailed Web site content- Develop a web based real time application process- Develop marketing plan and supporting collateral- Identify and address regulatory and compliance requirements.

- Worked with contracted PPOs (Preferred Provider Organizations) to resolve issues with CompAdvisor software- Liaison between programmers and PPOs to build and convert provider network data to meet system requirements- Implemented systems to track and resolve system issues in a timely manner- Performed data analysis to identify inconsistencies and potential business issues - Liaison between vendors and programmers when installing additional cost saving software modules to CompAdvisor

- Project manager for converting/implementing companywide healthcare information systems- Worked directly with the system vendor and their programmers to insure the software would meet business requirements- Project manager for companywide Y2K conversion- Lead IT Liaison for regulatory audits and IT communications- Work with consultants to identify and automate business needs - Liaison between vendors and programmers when installing additional cost saving software

- Worked with 7 independent health plans to create a singular data interface with the LA Care IT System- Wrote and performed Plan Partner system regulatory annual audits on all 7 contracted Health Plans- Wrote and maintained data dictionary for each of the 6 file formats that interfaced with the 7 contracted Health Plans- Managed the entire EDI process between LA Care Health Plan and 7 subcontracted health plans- Personally insured timely delivery of electronic eligibility files to each subcontracted health plan. Key to maintaining compliance with state requirements- Formally documented all issues dealing with plan partner system compliance

- Liaison to 26 subcontracted Independent Physician Associations and Medical Groups - Worked with provider groups to resolve member issues, provider issues, and claims issues- Performed NCQA physician office audits - Assisted in the implementation of Cal Optima for Universal Care Health Plan’s staff model clinics- Assisted in the implementation of new corporate Healthcare system - Worked with executive leadership to implement new healthcare delivery initiatives

IPA ManagementCredentiallingBusiness Analysis

Maintain Physician Credential RecordsWork with Contracted HMOs during AuditsWorked with Providers to insure timely submission of credential documentation

B.A., English

Activities and Societies: Internship with the Riverside County Philharmonic

Bachelor Of English