Kara Goff Email & Phone Number

Linthicum Heights , Md, Us

Provides executive administrative support to the SVP of North American Sales.Supports Sales department activities include organizing and prioritizing large volumes of meetings, coordinating partner training and events, assisting with sales team members with presentation materials or client support as neededActs as a project manager for special projects, which may include planning, coordinating, multiple presentations, disseminating information, and organizing company-wide or location specific events.Assist the Legal department with Certificates of Insurance, Customer Questionnaires, contract review/routing and document filings.Supports Human Resources with onboarding, office management, sales recruiting needs, career fairs and company event planning

The Project Management (PM) Specialist is responsible for the Vendor Oversight project and providing administrative support to the Project Management office The Vendor Oversight project consists of communicating with business owners to locate existing contracts, review for completeness and analyze for all of the project requirements. Each contract is uploaded and tracked within SharePoint to provide weekly status reporting to the Director of PMO and monthly status reporting to the CEOThe PM Specialist also provides secretarial support for the PM’s weekly project meeting and a weekly audit oversight of the Project Plans on SharePoint to ensure timely, accurate documentation has occurred

Client liaison overseeing the program management agreement, quota sale reinsurance treaty and sales agreement between Olympian Health Partners, Windsor Health Group and Fresenius Health Partners, a PPO Plan offered with Part D benefits. Provide change management for all aspects of plan implementation including development of reporting, creating file exchanges, daily business workflow and any other relationship oversight required. Provided comprehensive oversight for development and filing of all Fresenius marketing materials, which included over 75 documents filed with CMS for the 2013 plan year. Worked cohesively with Fresenius and Windsor completely overhauling the CMS filing of the Fresenius website, as applicable for the 2012 and 2013 plan year bid. Experience in the following: ComplyTrack (compliance and risk management software), SFTP sites, Nuance PDF Professional, Microsoft Project, Sharepoint, and Serena (change management software platform)

Held full responsibility for all post payment transactions. Managed annual portfolio of $12 million in refunds and oversaw 25-30 direct reports. Managed and monitored the workflow of claims processing to ensure the accurate and timely processing of claims per CMS/Medicare and internal business requirements. Created and maintained department policies and procedures as well as coordinated training documentation for the staff.

Classify, log, track, research, resolve, and respond to appeals and grievances according to CMS, Compliance and internal Sterling guidelines. Supplemented department training for staff and provided support to the AG unit with processing of Timely Filing Appeal decisions. Provided direct support to the CMS Plan Sponsor in resolving high profile issues. Worked in conjunction with VP of Compliance to resolving Balance Billing issues, Secondary Provider Appeals and DOI complaints. Developed and improved the current internal processes according to CMS guidelines per 2006 audit feedback.

Maintained refund check balances, surplus checks with letters, and surplus void batches according to CMS guidelines and regulations. Created & updated all current task documentation related to workflow for posting refunds, surplus letter batches, and surplus void batches. Business point of contact for AIM Healthcare Services recovery contract. Utilization of current software programs: QMACS (core claims operation platform), HCPCs (core claims operating platform), Macess (inventory routing system), IMAX (imaging system), Adminisource (electronic payment distribution software), Lotus Notes and Microsoft office. Performed hand-keying of all paper claims received for HCPCS claims system and provided secondary audit to daily payment run