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.

• 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.
• 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.

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.

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.