Susan Brown Email & Phone Number

Castle Rock, Colorado

Remote

Led the Payment Integrity Investigation and Validation Team with the development and implementation of process improvements, investigation and validation of vendor concepts, Works cross functionally to identify improvements with workflows and opportunities. Partnerships with other areas and vendors to effectively meet strategic commitments. Demonstrated competency in resource and project management: organizing work, providing leadership to staff, establishing measures for success, and managing deliverables. Leader in the hiring process, provides on-going coaching and employee development along with writing of performance reviews. Develops and maintains desk reference material for the team. Ensures new hires complete necessary training. Assesses training needs and plays an active role in the development of staff. Monitors staff workloads and work quality. Provides appropriate communication and documents for our outside partners as well as our internal customers.

Remote Worker

Led the Payment Integrity Investigation and Validation Team with the development and implementation of process improvements, investigation and validation of vendor concepts, Works cross functionally to identify improvements with workflows and opportunities. Partnerships with other areas and vendors to effectively meet strategic commitments. Demonstrated competency in resource and project management: organizing work, providing leadership to staff, establishing measures for success, and managing deliverables. Leader in the hiring process, provides on-going coaching and employee development along with writing of performance reviews. Develops and maintains desk reference material for the team. Ensures new hires complete necessary training. Assesses training needs and plays an active role in the development of staff. Monitors staff workloads and work quality. Provides appropriate communication and documents for our outside partners as well as our internal customers.

Remote

Supervises a team of 18 Investigators and a resource for Subrogation and Other Party Liability professional and support staff. Oversees and coordinates team activities to achieve business objectives by ensuring consistent standards, measurements, processes, reporting is developed and implemented to maximize savings in all situations where another party is responsible to pay for treatment of members’ injuries or illnesses (e.g., accidents, Worker’s Compensation, etc.) on all lines of business. Excellent skills in setting priorities for a team and overseeing work outputs and timelines. Ability to communicate effectively, verbally and in writing including with members, employer or provider groups and various levels of management. Effectively develop and lead the team including employees who may be in multiple locations or work remotely. To recognize problems and effectively resolving complex issues. Possess working knowledge in the health insurance industry trends and technology. Uses best practices and designated standards. Organize, plan and prioritize assignments within multiple projects. Fluent with legal principles and State and Federal Laws governing other party liability and Subrogation. Apply my knowledge of claims management processes and procedures for multiple product lines.

Salt Lake City, Ut

Investigate complaints of fraud and abuse from subscribers, providers, internal and external sources. Conducts, coordinates and leads highly complex external audits and investigations. Participates in post audit exit interviews with providers and post-audit education to providers to correct discrepancies. Equitable contributions to the investigative unit and a high level of expertise in a variety of case types as well as broad general investigative knowledge. Provide mentoring and guidance to team members. Lead role in training at both the department and corporate levels. Accurate accounting of funds recovered as a result of audit activities, criminal or civil convictions and settlements. Negotiation on recovery settlements. Collection of recovery dollars. Maintains current knowledge of policies, regulations and laws. Participates in formulation and improvement of company policies.. Maintains contact with the provider community, during audits and investigation along with providing education. Represents company for both external and internal meetings dealing with fraud and abuse issues. Participates in litigation proceedings, and testifies in court as required. Research of various agencies for local and national fraud along with abuse schemes. Support CMS and/or other investigative agencies. Conduct interviews of witnesses, informants, subject area experts and/ or targets of investigations. Identify, collect, preserve, analyze and summarize evidence, examining records, to verify the authenticity of documents. Preparation of affidavits or supervise the preparation of affidavits as needed. Initiate and maintain communications with law enforcement and appropriate regulatory agencies.

Salt Lake City, Ut

Manage a startup vendor project from start to finish. Created and implemented policy and procedures for the DME Vendor Project. Created a tracking system of the project. Implemented a procedure of claims adjustments was implemented throughout the department. Created an environment of a productive problem solving relationships between the Vendor, Provider and various departments within Cambia Health Systems. Prepared reports on the status of projects. Reviewing Provider audits. FEP Reporting. Working on Level I, Level II appeals and mediations. Collections on recovery dollars. Creating and presentation of projects to various levels of management. Tracking of deadlines. Team building. Follow up with various departments to ensure they are on task to meet a deadline. Creating template letters and documents for the project. Process recovery payments. Audit Investigation Innovation of new ideas to improve the processes of the projects. Chairperson Project Manager of the Cambia Health Giving Campaign in Utah for 2013.

Salt Lake City, Ut

Manage all research data obtained from studies. Managed and maintained flow of the research studies. Coordinates and populated the research data entry into the Neonatal Research Network as well as data forms for other research databases. Prepared and maintained protocol of all research and regulatory binders. Work with medical personnel to ensure completeness and accuracy of data. Develop protocol of all studies Created Excel spreadsheets for tracking purposes. Coordination of various vendors to maintain appropriate protocol and accuracy of research data. Maintain the IRB, NICHD, NIH and other regulatory documents and research correspondences. Audits documentation. Participates in quality assurance. Documentation of meeting minutes. Ships all documents, DVD’s and other study materials as required in a timely manner.

Tacoma, Wa

Provide support and education for the TRICARE providers in the state of Washington. Assist with contracting for TriWest. Research and resolve provider issues with claims, billing or contracting. Advocate for the providers. Maintain retention of the contracted providers. Participate in TriWest provider seminars, PSAEC meetings held on military bases and conference calls between Net Sub Contractors. Create and maintain reports, spreadsheets and tracking logs. Developed and maintain the TriWest Teamroom. Update Provides of changes made by Congress or TriWest. Responsible for tracking the general education for providers and tracking monthly reports from TriWest and Regence. Ensured Regence was in compliance with our contract. Provided Providers with educational support. Prepare presentations and presented presentations.

Portland, Or

Administrative duties include: Data entry (including InterPlan). Create and maintain files, spreadsheets and logs. Attend the RFI Conference Call meetings, take notes, compose the minutes and email out to the RFP Coordinators. Assist the Bid Coordinators in preparing bids by making tabs, populating and collating the bid binders. Booking travel and preparing travel packets. Event planning and project management of RFP Summit. Designing invitations, documentation design, covers and spines for bids. Worked on the Medicare RFP. Maintained all printers and copiers. Scheduled appointments and meetings. Scanning documents for RFPs. RFI and Provider Disruption exposure. Tracking and presentation our department budget to management. Developing organization charts. Populate the InterPlan database. Update the Teamroom with current information.

Bellaire, Tx

Planned all marketing events, conferences and conventions for the United States office. Prepared and maintained the budget for the department. Located National and International events that would market our company to result in increased sales. Worked with in budget. Composed all correspondences for the marketing/sales department. Responsible for all printed advertisements in trade magazines, advertisements and publications. Ensured all deadlines were met. Attended all sales offsite meetings. Made all airlines, hotel and other necessary travel arrangements for the staff and clients. Trained in the operations department and would assist when needed. Preparation of a vessel’s arrival / departure reports, bills of lading, customs reports, tracking the vessel’s voyage and informing customers of the status of their cargo. Answered telephones and directed calls. Maintained records, files and information for the marketing department. Stayed current with heavy email volume. Supplied exceptional customer service for clients and potential clients. Tracked shipments, arranged for proper equipment to be at the Port in an appropriate time with the arrival or loading of a vessel.