• Led teams of 8 and then 24 auditors through audit transformation processes to improve focus on regulatory compliance and uniformity of audit approach.• Increased auditor efficiency by 40% via improvements in audit design and technology.• Designed and built audit database structure to introduce data controls and aggregate reporting functions, leading to a 20-point increase in care management compliance scores.• Developed positive communication/rapport between audit team and clinical leadership.• Created and administered Inter-rater Reliability (IRR) testing for Behavioral Health clinicians.• Managed vendor relationship for after-hours call center and crisis call triage, increasing service level to >80% and ASA to under 30 seconds.• Led four annual cycles of successful Model Audit Rule (SOX) testing and validation.• Investigated potential HIPAA, marketing, human resources, and code of conduct violations.• Identified $65 million in first year savings via audits (stop-loss, 340B, pass-through payments, premiums/enrollment, and accounts payable.)• Prepared plan for regulatory audits (DOH, CMS, NCQA).• Drove case generation for first year of start-up SIU through data mining, reporting, and analysis, leading to $2.5 million in recoveries, and in excess of $10 million in first year savings.• Created design specifications for the Special Investigations Management System (SIMS.)

• Publisher of Wildy’s World, a music and entertainment blog with a focus on Independent Music with over 3,000 reviews published and over 1,000,000 page views.• Freelance biographer and copywriter for independent artists and Public Relations firms.• Reviews have been published or quoted on The Independent (UK), CelticMP3.com, NoDepression.com and ReviewYou.com.

• Managed Primary Care Physicians Incentive Program through eight successful payment cycles.• Managed the HEDIS CAHPS survey process, coordinating data creation and validation with outside vendor.

• Developed Fraud and Abuse Coordinator position.• Acted as account management liaison for a major client for claims issues.• Performed claims processing, adjustment and audit functions as needed in support of the Claims Audit Department.