Kimberly Rieve Email & Phone Number

Los Angeles, Ca, Us

Orlando, Florida Area

• Conducted pharmacy benefit manager (PBM) licensing and submission requirements investigations, performing 500+ formal regulatory filings to secure compliance with state and Federal regulations. • Implemented document management process improvement, spearheading system transition to cross-collaborative technology platform to initiate trackable and auditable licensing processes.o Effectively trained team on SharePoint logistics to ensure optimized communication. • Analyzed and researched pending legislation, overseeing data analysis, literature review, and best practices to guarantee procedural and regulatory compliance across all 52 states.• Effectively conducted policy and procedure reviews to secure alignment with Centene Corporation mission and ethics as well as local, state, and Federal legislation.• Secured timely form submission to safeguard viability and standard operating procedure (SOP) compliance.

Dayton, Ohio Area

• Researched, analyzed, summarized, and implemented laws and regulatory requirements across the organization, enforcing compliance with state and Federal regulations, including meeting deliverables for filing submissions.• Researched regulatory and submission requirements for applicable submissions, reporting, and deliverables and communicated requirements to internal business owners and leadership.• Coordinated cross-functionally with business owners for the on-time delivery of required documents prior to submission to regulatory agencies.• Fostered collaborative relationships with regulatory agencies and other industry stakeholders as the primary liaison between CareSource and all regulatory entities.• Provided timely and concise replies to requested data, inquiries, or reports from regulators.• Processed product-specific inquiries from internal and external business partners and regulatory agencies, researching, analyzing, and reporting on trends related to inquiries.• Spearheaded research and drafting efforts regarding the instituting of a new Compliance plan and Standards of Conduct documentation. • Performed front-end information gathering for potential self-disclosures, ensuring timely form submission.

Dayton, Ohio Area

• Served as the lead paralegal for Medicare Advantage and Georgia Medicaid provider network adequacy internal audits, ensuring alignment with provider network adequacy requirements.• Collaborated with attorneys and business partners on healthcare and business matters, including provider, vendor, and government contracting, business licensure, and litigation, regulatory, and subrogation support.• Managed litigation holds, responded to subpoenas, and produced documents and interrogatories.• Compiled and presented legal research concerning healthcare-related issues such as Medicaid, Medicare, Medicare Advantage, Dual Eligibilities, and the Healthcare Exchange.• Implemented a company-wide electronic signature solution, streamlining the execution of vendor contracts.

Bachelor Of Science - Bs, Criminal Justice

Associate Of Applied Science - Aas, Paralegal Studies