Sandy Brooks Email & Phone Number

Seattle, Washington, United States

Www.Slbrooksconsulting.Co.

 Accreditation and Compliance: Over six years of Accreditation Program management with a focus on NCQA survey preparation, document management, auditing, loading and storage within the NCQA IRT System and final submission, along with management of Single-Site, Multi-Entity documents. Awarded near-perfect scores for multiple lines of business on the NCQA Standards and Guidelines (Quality Management and Improvement, Network Management, Utilization Management, Credentialing and Recredentialing, Members’ Rights and Responsibilities, Member Connections, and Population Management). Maintains knowledge of changes to NCQA Standards through annual education and training, including the most current addition of the Population Management Standard domain, and is proficient in preparing and loading documents for Single Site, Multi-Entity surveys. Project Management, Crisis Management and Training: On-site project and crisis management. Expertise in educating teams on NCQA Accreditation program requirements, naming conventions, bookmarking, linking and IRT loading, in preparation for final survey. Systems/Software Knowledge: Strong knowledge of NCQA’s newly implemented Interactive Review Tool (IRT). Proficient in both Adobe and Nuance Systems. Leadership: Lengthy background in health plan leadership, serving in both management and director level positions.

ACCREDITATION & MEDICARE PROGRAM MANAGER• Responsible for compliance expertise in interpretation, recommendations and education oversight and implementation of comprehensive compliance and regulatory evaluations using processes, systems and results to assess the clinical and service quality and regulatory compliance of Premera programs, while ensuring program deliverables are clearly defined and completed.• Provided strategic project management services to improve business processes and ensure regulatory requirements through audits and analysis of data relative to compliance activities. • Developed a collaborative environment through management of an effective, high-performance team whose performance resulted in earning a “Commendable” NCQA rating during the initial 2013 NCQA Accreditation Survey and a near perfect score in 2017 for NCQA Standards for Premera’s four lines of business.

Consulting at a Medicare Managed Care company in North Carolina with a focus on identifying and implementing process improvements, increasing productivity and product knowledge, ensuring regulatory compliance, and preparing for an upcoming CMS audit.

Responsible for comprehensive service company with focus on collection of outstanding Accounts Receivables of Medicare, Medicaid and Commercial claims. Oversight of strategic management, operational competencies and business development. Consulted with medical providers and staff on the development and maintenance of accurate and timely billing practices, increased efficiencies and improved medical records, ongoing regulatory compliance, development of processes, policies and procedures, reduction of operational costs.Established critical partnerships with insurance carriers to resolve claim payment delays due to pended or denied claims, thus increasing profitability for the provider.

Responsible for oversight of the strategic management and operational oversight of Operations Departments consisting of four Operational areas (Member Services Call Center, Retention, Appeals & Grievances, and Enrollment Services), three managers and 75 employees.

Directed the day-to-day effectiveness of a five unit Medicare and Commercial Operations Department (Member Services Call Center, Enrollment Services, Claims Research, Provider Transition and Appeals & Grievances Departments) consisting of five managers and 200 employees and annual budget of over $50 million.

Managed Medicare Member Services Department (Call Center, Claims, Medicare Appeals and Grievances Department and New Member Liaison Unit) consisting of three supervisors and 100 employees.