Project Manager Customer Service
Resume:
Rebecca Cowling
**************@***.***
SUMMARY
Rebecca Cowling has more than 25 years experience in management, consulting, government
operations, healthcare services and operations. Her experience includes skilled leadership, compliance,
business development, and customer relationships. Ms. Cowling served as an advisor for two White
House administrations, congressional members and staffers concerning healthcare and legislative actions
as well as the Department of Health and Human Services and Centers for Medicare and Medicaid
Services (CMS) on regulatory mandates. She organized multiple national healthcare meetings for HIPAA
NPRM creation and implementation (sessions included 1,000 people from DHHS, HCFA (CMS), national
payers and vendor organizations. Six Sigma Champion certification.
October 1999 – Present
The Blackwood Group, Owner
Creation of ISO 9000 Quality Management System for certification
Ensure quality objectives are measureable and meet specified requirements and are established
within the Organization.
Responsible for taking corrective action to correct nonconformance.
Ensure that appropriate communication processes are established within the organization and
that communication takes place regarding the effectiveness of the quality management system by
scheduled meetings, newsletters, intranet site, email announcements, and training
Customer and project management for healthcare operations, including regulatory compliance
and privacy projects.
Contract negotiation, business development, BPR operations assessment and evaluation, staff
development and customer liaison.
Responsible for sales strategy, tactical planning, hiring of staff, and development of the target
market.
Leadership of Quality measurements including definition, criteria, and data analysis, including
ISO 9001:2008 Certification
Ensures quality and regulatory compliance according to state and federal legislative policy
mandates
Oversight of internal and external audits
Quantify quality objectives, making sure they are measureable and meet specified requirements
and are established at relevant functions and levels within the Organization.
Major Projects include:
Major Projects Responsibilities
ISO 9001:2008 Consultant Creation and implementation of Quality Management
System
First Health Services Corporation Subject Matter Expert for government healthcare initiatives
(Coventry) HIPAA and regulatory compliance within new business
development infrastructure
North Carolina Division of Medical Division of Medical Assistance (Medicaid) Privacy Official
Assistance Project management and direction for Department / Division
Created General and Operational Privacy Policies and
Procedures
Development of HIPAA Security Policies and Procedures for
NC DHHS
Confidential
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DC Medicaid Assistance Program Primary point of contact for customer relationship
development
Responsible for developing requirements related to EDI
implementation.
Directed design of the enrollment process to verify that all
information required for members and claims were
captured.
Managed matrix organization comprised of technical and
professional employees.
South Carolina Department of Health and Project Manager and oversight for Privacy Assessment, Gap
Human Services Analysis and policy development for the SC Department of
Health and Human Services
Preparation of Legal Analysis of SC legislation for HIPAA Pre-
emption Study
Arizona Department of Economic Evaluation and analysis of HIPAA training requirements
Assistance Preparation of EDI, Privacy and Security curriculum for the
State of AZ
Maine Department of Health Services HIPAA Privacy and Security Training curriculum development
Blue Cross Blue Shield of Montana EDI Assessment and Gap Analysis of commercial healthcare
EDI applications and processes.
Assessment of EDI applications and programs to ensure
operational efficiencies
Harvard Pilgrim Health Plan EDI Assessment, Analysis and Process Re-engineering
including claims operations, customer service, and
operations areas
Assisted in the final recommendations for process re-
engineering for cost effective business processes
December 2004 – March 2012
Magellan Medicaid Administration
Corporate Compliance Director
Oversight of complex projects/programs necessitating the origination and application of efficient
approaches to accommodate regulatory requirements
Investigation of potential fraud and breach reports
Ensures contract and regulatory compliance according to state and federal legislative policy
mandates and contract requirements
Provided documentation and requirements for State Medicaid Certification status
Participates in national healthcare standards organizations – NCPDP, WEDI, DISA, NMEH
Identifies, analyzes and makes recommendation regarding key legislative issues
Works closely with government and national healthcare industry leaders to build coalitions to
effect change that will have a positive impact
Ensures corporate initiatives are implemented to achieve optimum results
Provides oversight to functional managers, directors and senior management regarding
compliance
Management of external Customer audits; SAS 70 Type II, HIPAA Security, SOX and Financial
Develops positive relationships throughout enterprise and communicating with staff at all levels
Researches, monitors, and analyzes federal and state legislation and planning activities related to
government funded initiatives and CMS regulatory changes
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National Data Corporation
Director Government Sales
October 1995 – October 1999
Creation of Government line of business for national healthcare clearinghouse selling more
than $200 MM in new business via target market plan strategy, alliances and technology
partnership opportunities.
Electronic Data Systems
National EDI Director for State Operations Division
State Operations Division
April 1988 – October 1995
Designed, managed and implemented the first national software application for electronic
transmission of Medicaid healthcare claims;
Creation of the national EDI strategy for the State Operations Division and 23 Medicaid state
programs including Project management and implementation of EDI applications and
connectivity
Managed the remote and matrix EDI staff and systems engineers. Responsibilities included
monitoring and reporting project status, performance reviews, salary/bonus administration,
budget development, goal setting, and profit and loss responsibility
Advancing the profitability of a Fiscal Intermediary for government operations by an
estimated $500 Million annually via operational efficiencies
Successful program management of EDI applications and interfaces
Created process for Business Associate Agreements and Trading Partner Contracts
Business and functional leadership in the implementation of middleware and translator
applications
PROFESSIONAL ORGANIZATIONS
National Association for Electronic HealthCare Transactions (AFEHCT) Chair; lead the integration
of the organization with the Work for Electronic Data Interchange (WEDI)
American National Standards Institute (ANSI).
National Council of Prescription Drug Programs (NCPDP)
Workgroup for Electronic Data Interchange
o WEDI SNIP
Government Agencies Sub-Workgroup; Co-Chair, Data Review Workgroup; Co-
Chair; Business Issues Workgroup; Co-Chair NPI Workgroup
APPOINTMENTS AND LEGISLATIVE WORK
Political appointments:
First Chief Procurement Officer in the State of Arkansas
Chief Probation Officer, Little Rock Criminal Court
Governor’s Liaison Officer to the Arkansas Department of Corrections
Creation of law and regulatory guidelines:
Arkansas Procurement legislation
Arkansas Probation and Parole Officers’ legislation including Code of Ethics
Healthcare Insurance Portability and Accountability Act (HIPAA)
Confidential
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University of Arkansas at Little Rock
Visiting Professor – Criminal Justice
EDUCATION
Ouachita Baptist University
Arkadelphia, AR
Political Science
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