Rebecca Sullivan Email & Phone Number

United States

Jacksonville, Florida, United States

Jacksonville, Florida

Provide consulting services to ensure compliance with legal and regulatory requirements

Jacksonville, Florida

Management and oversight of Medicare Regulatory Requirements, Compliance and Star Ratings as they relate to Enrollment, Maintenance and Billing Operations for Medicare Health Insurance within Florida Blue. Lead and manage a team of Operations Managers, Specialists and Analysts to ensure compliance with CMS regulatory requirements for Medicare Part C and Part D products. Development and implementation of risk based strategies for Medicare products to ensure that operational, financial and strategic controls are operating with minimal risk to the business. Leading numerous Compliance and Medicare Member Experience strategies and initiatives to improve our member loyalty, improve revenue optimization and increase our Star Ratings with CMS. High level of management oversight and tight controllership over process improvements to drive business outcomes and strategic imperatives in alignment with the company’s strategic objectives, mission and vision. Provide an integrated, risk-based approach in managing the Medicare EM&B operations to ensure strict adherence to Federal and State regulations, including the Centers for Medicare & Medicaid Services (CMS), Office of Insurance Regulation (OIR), and Health Care Reform (HCR). Medicare Compliance Committee Member, 2013-present.

Jacksonville, Fl

Management and oversight of Medicare Regulatory Requirements and Risk management as they relate to Enrollment, Maintenance and Billing (EM&B) of Florida Blue. Lead and manage a team of 11 Process Improvement and Compliance analysts to ensure compliance with CMS regulatory requirements for Medicare Part C and Part D products. Development and implementation of risk based strategies for Medicare products to ensure that operational, financial and strategic controls are operating with minimal risk to the business. Leading numerous Medicare Member Experience strategies and initiatives to improve our member loyalty, improve revenue optimization and increase our Star Ratings with CMS. High level of management oversight and tight controllership over process improvements to drive business outcomes and strategic imperatives in alignment with the company’s strategic objectives, mission and vision. Provide an integrated, risk-based approach in managing the Medicare EM&B operations to ensure strict adherence to Federal and State regulations, including the Centers for Medicare & Medicaid Services (CMS), Office of Insurance Regulation (OIR), and Health Care Reform (HCR). Medicare Compliance Committee Member, 2011-2013.Major accomplishments: Risk Management: • Improved Medicare Part C and Part D Risk Index by 36.4% within two years by providing strong leadership, direction and management oversight of enrollment, disenrollment, maintenance and billing processes. • Drastically reduced (eliminated) volume of open, high risk Internal Audit Findings from 2011 to 2013. Regulatory Requirements: • Significantly reduced volume of controllable Medicare Complaints (CTM’s) by 81% from 2011 to 2013. • Substantially reduced volume of Retroactive Enrollment and Disenrollment Errors by 57% from 2011 to 2012.

Jacksonville, Fl

As Senior Paralegal, I was responsible for ensuring compliance with Federal and State regulations for complex litigation and appellate cases. Managed legal projects from investigation through the discovery process and mediation or trial.Responsible for a broad range of HR and supervisory duties that included recruiting and interviewing support staff, training and directing others in internal processes and regulatory guidelines and procedures. Managed billing processes and monthly productivity reports, ensuring that the firm's productivity goals were achieved.

Jacksonville, Fl

Provided management oversight and direction in litigation cases by ensuring compliance with Federal and State regulations, mitigating risk to clients, providing trial consulting, investigating, training and development to staff for local area law firms, particularly small to mid-sized firms.

Paralegal Litigation Management for major insurance companies (health insurance and liability insurance) and Fortune 500 companies. Ensured strict compliance with federal and state guidelines, statutes and court procedures by preparing legal pleadings and meeting deadlines for all legal projects in my department.

One of the most enriching parts of my career was serving as President for two years for this local paralegal, non-profit association. Served on the Board of Directors, directed group processes, and conducted meetings and presentations to many professional, legal groups in the Jacksonville community. During my time as President, membership of the organization grew by 22% in one year alone.

Litigation Paralegal for Medical Malpractice and Products Liability department, representing major insurance companies, health care providers, medical facilities, local hospitals and nursing homes.

Litigation Paralegal for complex tort litigation department for this prestigious and nationally acclaimed law firm. Ensured strict compliance with local, State and Federal regulations. Prepared complex litigation cases for trial. I traveled out of town to oversee mass document productions and attended Anti-Tobacco litigation conferences.

Master'S Degree, Management And Leadership, Graduated Magna Cum Laude (3.90 Gpa)

Activities and Societies: Beta Sigma DeltaGraduated with Distinction

Bachelors Of Science, Psychology, Graduated Magna Cum Laude, 3.8 Gpa

Certified Paralegal, Paralegalism

Substantive areas of law: Contracts, Litigation and Torts

Licensed Realtor, Residential