Kimberly Rieve Email & Phone Number

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.
• 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.

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