•Acquired knowledge of new systems and achieved integration with Anthem's compliance department.•Review, investigate, and collaborate with Care Management Directors on New York State Department of Health (DOH) member complaints and ensure satisfactory resolutions. •Manage Department of Financial Services provider complaints by collaborating with the claims department.•Develop and present quarterly reports on DOH member complaints to the Quality Committee.•Manage… Show more •Acquired knowledge of new systems and achieved integration with Anthem's compliance department.•Review, investigate, and collaborate with Care Management Directors on New York State Department of Health (DOH) member complaints and ensure satisfactory resolutions. •Manage Department of Financial Services provider complaints by collaborating with the claims department.•Develop and present quarterly reports on DOH member complaints to the Quality Committee.•Manage internal and regulatory audit inquiries and preparation. •Review and process third-party medical record requests. Show less

•Conducted monthly reviews and approvals of 100 marketing events to ensure compliance with MLTC marketing guidelines.•Managed compliance hotline calls, investigations, and inquiries.•Managed DOH member and provider complaints.•Collaborated with key departments to ensure timely submission of MLTC quarterly reports. •Managed regulatory reporting calendar and ensured timely submissions.•Developed and presented quarterly reports at Compliance Committee… Show more •Conducted monthly reviews and approvals of 100 marketing events to ensure compliance with MLTC marketing guidelines.•Managed compliance hotline calls, investigations, and inquiries.•Managed DOH member and provider complaints.•Collaborated with key departments to ensure timely submission of MLTC quarterly reports. •Managed regulatory reporting calendar and ensured timely submissions.•Developed and presented quarterly reports at Compliance Committee meetings.•Reviewed and processed third-party medical record requests.•Participated in several integration meetings to facilitate the merging of Integra's compliance program with that of Anthem's. Show less

Corporate Oversight Manager (11/17-04/21) •Effectively promoted and maintained strong, positive working relationships with internal business owners, external customers, and members.•Communicated with Centers for Medicare and Medicaid Services (CMS) and DOH to ensure comprehensive resolutions to member and provider complaints.•Facilitated timely submission of all regulatory reporting requirements including maintaining and disseminating a reporting calendar… Show more Corporate Oversight Manager (11/17-04/21) •Effectively promoted and maintained strong, positive working relationships with internal business owners, external customers, and members.•Communicated with Centers for Medicare and Medicaid Services (CMS) and DOH to ensure comprehensive resolutions to member and provider complaints.•Facilitated timely submission of all regulatory reporting requirements including maintaining and disseminating a reporting calendar to internal departments.•Performed operational monitoring and testing to identify and help address areas of noncompliance with CMS and DOH requirements.•Managed compliance hotline call investigations, conflict of interest disclosures and exclusion check processes.•Ensured operating manuals and procedural documents stayed current when regulations changed.•Responded to inquiries from regulatory agencies and completed required compliance documentation.Site Community Manager (02/17-11/17) •Advanced to oversee a pilot initiative of a Program of All-Inclusive Care for the Elderly (PACE) site.•Responsible for day-to-day operations including the supervision of staff.•Developed individual professional development plans with direct reports.•Developed partnerships with community churches, schools, and NYPD. •Educated participants regarding PACE services.•Investigated members’ grievances and ensured satisfactory resolutions.Compliance Coordinator (06/16-02/17) •Supported Chief Compliance Officer with monitoring of day-to-day compliance activities including responding to compliance hotline reports, allegations of fraud and other concerns brought to the department. •Conducted compliance training for new hires.•Coordinated monthly sanction screening for over 3000 employees, physicians, and contractors.•Submitted regulatory filings and reports to the CMS and DOH. •Maintained a database of potential risk management issues. Show less