Lori Ewing Email & Phone Number

Louisville, Kentucky Area

Louisville, Kentucky

Louisville, Kentucky Area

Louisville, Kentucky Area

Reconciliation Team Lead (June 2011-July 2015) & Acting Manager (April 2015-July 2015) -Department Relocation to Denver, Colorado as of 07/25/2015. Managed the Reconciliation team of 18 fulltime associates. Performed evaluations, associate development, and quality assurance. Ensured CMS and Company business standards were met and/or exceeded. Monitored quality and production to associates; provided coaching improve performance and accuracy; ensured continuous improvement and achieve… Show more Reconciliation Team Lead (June 2011-July 2015) & Acting Manager (April 2015-July 2015) -Department Relocation to Denver, Colorado as of 07/25/2015. Managed the Reconciliation team of 18 fulltime associates. Performed evaluations, associate development, and quality assurance. Ensured CMS and Company business standards were met and/or exceeded. Monitored quality and production to associates; provided coaching improve performance and accuracy; ensured continuous improvement and achieve Company goals. Major Accomplishments: • Implemented policies and procedures that are CMS compliant while focusing on continuous improvement.• Maintained current knowledge of CMS compliance requirements as they pertain to Medicare Advantage enrollment and member maintenance and translating those requirements into actionable solutions.• Prepared monthly audit files received from the RPC (Retroactive Processing Contractor) for validation of transactions sent to CMS for Enrollments, Disenrollments, Cancellation of Enrollments, Cancellation of Disenrollment, Residence Address changes. • Analyzed CTM (Complaint Tracking Module) cases to determine root cause and plan of action to prevent future complaints. Focused on improving inventory turnaround times, reduction in CTM’s, system enhancements and process improvement to increase plan star ratings. • Analyzed and assisted in resolving system errors. • Attested to the monthly membership reconciliation which was sent to Upper Leadership to send to CMS.• Analyzed monthly submissions for retro-activity to determine root cause and plan of action to prevent future retro-activity on controllable actions. These submissions required Company Compliance and CMS Region Office prior approval before sending to the RPC. Show less

Manage the Reconciliation team of 18 fulltime associates. Perform evaluations, associate development, and quality assurance. Ensure CMS and Company business standards are met and/or exceeded. Monitor quality and production and provide coaching to Reconciliation associates to improve performance and accuracy to ensure continuous improvement and achieve Company goals.