MCMG Division of Performance Assessment

• Conducted Quality assessment Surveillance Program audits for Medicare Administrative Contractors• Implemented and conducted the Pilot Focused Review for Medicare Administrative Contractors• Served as Technical lead on Office of Inspector General and Government Accounting Office studies to ensure all requirements are met and operationalized• Reviewed and Analyze Quality Assessment results to clarify policy and write policy changes.• Reviewed Medicare Administrative Contractors and provide written reports of performance to Contracting Officer Representatives • Reviewed Program Issues to draft policy documents related to the Provider Enrollment process.• Conducted research to address program vulnerabilities• Provided Technical Assistance on enrollment requirements• Provided ongoing monitoring of compliance with Federal and Agency requirements

• Monitored and provided policy assistance to Medicare Administrative Contractors.• Reviewed and provided analysis to Contracting Officer Representatives and Technical Monitors• Reviewed Program Issues to draft policy documents related to the Provider Enrollment process.• Prepared written correspondence regarding provider enrollment to the public, Congressional staff and other external contacts.• Provided assistance to Provider community with questions and issues. • Conducted research to address program vulnerabilities• Provided Technical Assistance on enrollment requirements• Provided ongoing monitoring of compliance with Federal and Agency requirements. • Recruited by Provider Enrollment Oversight Group for knowledge

• Maintained extensive knowledge of all Provider Enrollment Part A and Part B processes and procedures including Centers for Medicare and Medicaid Services (CMS) policies, PECOS, E-Chimp, MCS and FISS.• During absence of Operations Manager, lead team and monitored Provider Enrollment projects to support departmental goals.• Conducted interviews with providers regarding their Medicare enrollment• Performed Onsite visits for Independent Diagnostic Testing Facilities and other suppliers d throughout the State of Florida • Daily functions required researching and interpreting CMS and CFR rules and regulations• Validated data and information submitted on Provider Enrollment Applications• Extensive knowledge in PECOS (Provider Enrollment Chain & Ownership System)• Current project experience within the Provider Enrollment Area including Operational referrals and Provider Enrollment Tracking System implementation• Managed implementation of the Provider Enrollment Tracking System• Provider Enrollment representative in multiple workgroups and conference calls• Participated with the Program Change Management department by developing procedures, processes and training curriculum for Provider Enrollment department• Provided effective interactive oral presentations and training for new employees, existing employees and Management.• Participant in the Issues Management Workgroup to resolve claim issues.• Researched provider claim denials and rejections to determine Provider Enrollment errors