Manager Management

ALESHKA BURGOS-COLON

***** ********** **. ********, ** 34711

Phone: 352-***-**** E-mail: *********@*****.***

EXECUTIVE PROFILE

An accomplished Healthcare Compliance Professional with extensive experience with regulations and

guidance of Managed Care Programs provided to elderly and medical indigent population. Expertise in

providing advice to insurance organizations to secure wide-compliance with applicable laws and

regulations. Highly skilled in all facets of:

Regulatory / Compliance Policies and Procedures Development Project Management

Staff Development Compliance Training and Education CMS Oversight Coordination

PROFESSIONAL EXPERIENCE

VACO Staffing Orlando, Florida 2012-

present

Vaco Orlando specializes in partnering the strongest professionals for project and permanent needs of its

clients.

Business Analyst (Medicare Part D Project)

• Support VP of Clinical Services in Part D line of business implementation.

• Serve as a consultant for different departments of the organization such as Call Center to provide

guidance according CMS’ regulations.

• Create and review policies, procedures and trainings for coverage determinations and

redetermination processes.

• Train Clinical Department staff about coverage determination and redetermination procedures.

TRIPLE S SALUD San Juan, Puerto Rico

2011-2012

An independent licensee of the BlueCross and Blue Shield Association, serving residents and businesses

in Puerto Rico. Also serving Medicaid eligible population due to government contract.

Medicaid Compliance Officer, (2011-2012)

• Designed and implemented the Compliance Program that was composed with the 7 elements for

a Compliance Program for the Medicaid line of business.

• Created and promoted compliance culture supporting the compliance with the government

contract within the organization.

• Established an effective line of communication with governmental agencies to fulfill ongoing

compliance requirements.

• Led a team of 3 Compliance Analysts for the execution of the Compliance Department goals

aligned with the Compliance Program.

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MEDICAL CARD SYSTEM, INC. San Juan, Puerto Rico

2006-2011

One of the principal health insurance companies in Puerto Rico that has been providing private and

Medicare Advantage plans for more than 29 years in the island.

Policies, Procedures and Education Manager (2010-2011)

• Managed a team of 3 Compliance Specialists for Policies, Procedures and Compliance Training.

• Implemented policy management software for the organization (Compliance 360 Policy Module).

• Trained Management Team for the utilization of the Compliance 360 Policy module.

• Accomplished the standardization process of management and review of policies across the

organization.

• Designed, provided and documented in a Compliance 360 Module Compliance Training for all

employees of the organization.

• Managed a team of 3 Compliance Specialists and 2 Compliance Technicians that were in charge

of compliance investigations and consultations from external and internal sources.

• Documented all cases in a database which I reported to the Compliance Officer for a corrective

action plan when applicable, to remedy compliance issues.

Compliance Specialist (2009-2010)

• Reviewed Part D and C Marketing Materials to be submitted for approval by CMS according to

the established guidelines.

• Developed tools and performed assessments/monitoring to operational areas and issued reports

with recommendations to the Compliance Officer and Senior Management for appropriate remedies.

Grievance and Appeal Specialist (2006-2009)

• Responsible for the investigations and resolutions of grievances and reconsiderations according

Medicare and Medicaid regulations and orientation to Medicare Advantage and Medicaid population

regarding timeframes and requirements according the type of cases.

• Named Subject Matter Expert to train the organization regarding the Grievances and Appeal

processes.

TRIPLE S SALUD San Juan, Puerto Rico

2002-2006

An independent licensee of the BlueCross and Blue Shield Association, serving residents and businesses

in Puerto Rico. Also serving Medicaid eligible population due to government contract.

Executive Secretary (2002-2006)

• Responsible in providing all clerical activities that included answering all department phones lines

and transferring to the appropriate extension, faxing, scanning documents to the Provider Services

Manager and other departments.

• Coordinated internal meetings calendar, prepared presentations, reports, letters, memos, document

control and filing.

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• Was in charge of coordinating the orientation process for the external providers.

EDUCATION

Bachelor in Business Administration with concentration in Office Systems

Universidad de Puerto Rico. 1997-2001

Continuing Professional Education

HCCA’s 15th Annual Compliance Institute

April 10-13, 2011, Orlando, Florida

18.90 / CCB Continuing education credits

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