Traci Gercone Email & Phone Number

Remote Associate

* Tested/Certified (4) Medicare Part D contracts for PDE (Prescription Drug Event) data submission* Tested/Certified (1) contract for Medicare & Medicaid Plan (MMP) Encounter file submission* Developed PDE standard operating process and procedures* Developed Claims re-adjudication (reprocessing) operating process and procedures / including SIU (Special Investigation Unit) Pharmacy Audits* Developed operating and monitoring process / procedures for Acumen audits* Business Owner for PDE and Claims Reprocessing* Weekly and monthly reconciliation with finance teams on all PDE and Claims Reprocessing operational activity* Company liaison for Claims Adjudication Software Vendor across all business lines* Program Management of projects related to Software Vendor across all business lines* Subject Matter Expert for various processes (e.g. Coverage Gap, PDE, EGWP, EOB, LTC Short Cycle)* Participate in NCPDP – including attendance of quarterly conferences* Travel to company locations, as needed

Remote Associate

* Monitor incoming guidance for three lines of business* Medicare Part D, Medicaid, and Health Insurance Marketplace* Input guidance into tracking system and assign to applicable business owners for impact analysis* Monitor guidance that requires action to completion for compliance effective date timelines* Report/distribute weekly statistics and client communication of received guidance * Host weekly regulatory review call to inform/educate internal associates of received guidance* Program Management of compliance projects* Subject Matter Expert for various processes (e.g. Coverage Gap, PDE, EGWP, EOB, LTC Short Cycle)* Participate in NCPDP, including Task Group Leader duties and attendance of quarterly conferences* Travel to company locations, as needed

Kansas City, Missouri Area

* Transfer to CMS Program Office’s (CPO) Front End Systems as Product Development Leader* First promotion to Sr. Product Development Leader* Second promotion to Product Industry Consultant* Participate in NCPDP, including Task Group Leader duties and attendance of quarterly conferences* NCPDP 2012-2013 recognitions include Rising Star Award and two MVP awards* Subject Matter Expert for various processes (e.g. Coverage Gap, PDE, EGWP, EOB, LTC Short Cycle)* Business owner front-end projects related to Medicare Part D (e.g. Coverage Gap Discount / MSP)* Work directly with IT staff and clients to build/create needed solutions* Assist in creation of detailed Business and Functional Requirement documentation

Kansas City, Missouri Area

* Transfer from DST Systems (finance) to Argus Health Systems (join healthcare industry)* Function as liaison between technical team and customer* Prepare and document all departmental procedures, financial information, and project information

Kansas City, Missouri Area

* Department transfer and promotion to Staff Financial Analyst Team Lead in Billing Dept.* Supervise team of three associates – quarterly and yearly reviews * Apply pricing to Network Proposals and upload financial journals into PeopleSoft financial system* Assist with month end reporting/analysis * Monitor and test Sarbanes & Oxley items monthly/quarterly