Yvonne Combs Email & Phone Number

Charleston, Tn, Us

Queens, New York

100 Church Street, New York, Ny 10007

Responsible for keeping the organization informed of new and or updated CMS and state regulations relating to the Medicare Advantage / FIDA lines of business, and ensuring that processes are implemented or updated to reflect compliance. Up going collaboration with Grievance and Appeals Dept. to provide regulatory guidance and act as liaison with the IRE / QIO. Review and approve all marketing materials prior to submission to regulatory entity. Responsible for Part C&D report submission and Data Validation process.

Melville, New York

Promoted corporate ethics and compliance within the organization. Collaborated with the audit team to develop the audit and compliance plan, and to identify and prioritize areas of significant risk. Developed and revised policies for the general operation of the Compliance Program. Developed and conducted annual compliance training, and ensured that delegated vendors were compliant with their annual compliance training. Investigated and responded to alleged violations and oversaw the overall system for handling such violations. Responsible for all regulatory reporting and Data Validation. Primary point of contact for CMS and DOH.

White Plains, Ny

Summarize and disseminate federal and state regulatory requirements to business units and senior staff, and ensure the implementation of new and updated regulatory requirements. Worked closely with all at risk departments and provided guidance when needed. Managed the annual ANOC/EOC notification and renewal process. Reviewed and submitted all marketing materials in HPMS. Represented the Compliance Department during executive meetings. Submitted Part C&D reports. Oversaw the CTM complaint review and investigation process.

Greater New York City Area

Reviewed completed cases for accuracy and compliance with federal and state regulatory requirements and timeliness. Reviewed correspondence to member or provider for completeness and accuracy of response, ensured that all concerns were addressed in the final response. Ensured that relevant internal stakeholders and delegated vendors were out reached during the investigation. Brought at risk issues to the compliance committee, provided recommendations for remediation to deficiencies. Assisted with gathering data for quarterly CMS reports. Assisted with training of appeals coordinators.