Assistant Health

Candyce Sutherland

412-***-**** adbnyk@r.postjobfree.com LinkedIn

HEALTHCARE PROFESSIONAL

Targeting Health industry

AREAS OF EXPERTISE

MS Office / SharePoint / JIRA / Software Development Process / Data Analysis, Assessing Outcomes / Understanding of HIPAA / Healthcare Policy and Regulations / Ensuring Compliance / Medicare Management / Handling Confidential Information / Research, Investigating, Reporting, Presenting / Developing Policies and Procedures PROFESSIONAL EXPERIENCE

ARDX Remote

Operational Policy Consultant September 2018-January 2020 Researched and analyzed the impact of legislative and regulatory trends and developed program evaluation concepts that met the needs of clients. Built partnerships for CMS to leverage for stakeholder engagement, state coordination, and enforcement follow-up. Had integrated team experience with the ability to translate data into policy, and policy into implementation. Served as a primary Point of Contact (POC) for the client and was responsible for maintaining and growing the line of business on the current contract.

• Served as the clients point of contact (POC) with an understanding of client goals and services that can be leveraged to help reach those goals.

• Responsible for continuously researching policy and regulations and applied knowledge to client goals.

• Facilitated client meetings, gathered requirements and acted as a trusted client partner

• Detected issues and investigated potential solutions

• Compiled information and professionally presented findings to clients

• Set schedules with the client and implemented agreed solutions

• Developed and implemented new procedures or training

• Served as a point of accountability for drafting of all policy and procedural manuals

• Offer a full suite of project management support services on multi-million-dollar contracts

• Performed other duties as assigned

UPMC Health Plan Pittsburgh, PA

Membership and Operations Analyst September 2014-September 2018 Obtained, organized and maintained documentation gathered from various departments in preparation for CMS audits, as well as reviewed documentation to determine whether it meets CMS requirements. Monitored CMS material and calls for required compliance and system or process changes.

• Developed process flows and complex reporting to support oversight capabilities to ensure performance standards meet all CMS requirements

• Wrote updates to standard operating procedures; policy and procedures

• Worked cross functionally and coordinated with others internally or externally to gather information

• Performed data extraction tasks using multiple databases

• Collaborated and developed strong business partnerships with Compliance and Business Owners of each functional area

• Produced and distributed weekly, monthly and annual key performance indicators

• Scheduled client and staff conference calls and meetings and drafted meeting minutes Gateway Health Plan Pittsburgh, PA

Credentialing Assistant March 2013-August 2014

Processed provider credentialing information, including verification of data in accordance with policies and procedures, to support network development and credentialing processes.

• Assisted in the review, recommendation, approval, and notification processes

• Exceeded production goals while maintaining quality

• Performed primary and secondary source verifications of credentials according to departmental policy

• Overseen all communications regarding cases and files; Exceed case goals and expectations for quotas EDUCATION & CREDENTIALS

Doctor of Health Administration, Healthcare Quality Analytics, In Progress, Capella University Masters of Business Administration, Healthcare Management Concentration, 2017, Carlow University Bachelor of Science, Business Management, 2015, Carlow University

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