Customer Service Management

Profile Overview

Seasoned and results-oriented management professional with demonstrated

experience in business and systems process evaluation and providing project

management for government audits from initial notice of site visit through

closing of all corrective action plans. Have strong knowledge in utilizing

emerging technologies that positively impact numerous business functions.

Acquired in-depth expertise in managing and analyzing business processes.

Skilled in systems and data analysis, and business process evaluations for

compliance, monitoring/auditing, regulatory risk assessment/mitigation, and

coaching on operational implementation of complex issues. Highly regarded

for spearheading major initiatives and adapting to rapidly changing

environments to ensure bottom-line results.

V Possess outstanding communication and leadership skills combined with

great work ethics and commitment to excellence; proven strong ability in

maintaining established relationships with all levels of professionals.

V Exemplified excellent communication skills, self-confidence, maturity,

and the ability to work well independently or as part of a team.

V At ease in high stress, fast-paced environments with numerous and

challenging tasks.

V Self-starter who can work independently and implement appropriate office

procedures as necessary.

V Proficient in Project KickStart, MS Word, Excel, Access, Outlook,

PowerPoint, and Adobe as well as with MS Windows (XP, Vista, 2000), Mac

OSX, and Lotus Notes. Working knowledge of Visio, UNIX, DB2, and C++

V Extensive experience in various proprietary mainframe and GUI

applications.

Core Competencies

< CRM Data Analysis

< Managerial and Leadership Skills

< Data Management

< Strategic Planning and Assessment

< Client Relations

< Rapid Conflict Resolution

< Business Reengineering

< Policy and Procedure

< Systems Integration

< Business Operations Devlopment

Career Highlights

Kaiser Foundation Health Plan, Inc. ( Pasadena, CA

Senior Consultant 1998-2010

Performed analysis of federal regulations and related business and systems

processes for implementation and monitoring requirements. Root cause

analysis of compliance issues. Implemented regular analysis of stored data

to ensure integrity of the data driving decision making. Took charge in

conducting routine internal audits including planning and management of

monitoring reviews and risk assessments with recommendations for

improvement. Directly reported all findings to Senior Leadership.

Supervised a full spectrum of on-site government audits. Designed and

developed training modules based on audit findings. Coupled with

operational departments as well as with information technology to manage

all operational risks. Generated various automated monitoring tools

specific to each monitoring area.

Notable Contributions:

< Gold Standard performance goal setting for compliant Claims and

Enrollment processing

< Ensured conformity with regulatory requirements in designing and

formulating multiple automated monitoring tools based on current

business and systems processes using MS Excel

< Functioned as subject matter expert in Medicare claims, enrollment,

and disenrollment; assessed all related company policies and

procedures to ensure process compliance with state and federal

regulations.

< Provided expert oversight and project management to various onsite

government audits.

< Strategically administered CMS Risk Adjustment Data Validation audits.

< Played a pivotal role as compliance partner on IT projects

System Conversion Tester - Testing Caseworker 1996-1998

Conducted interviews of various staff in order to distinguish work and

system flows. Comprehensively reviewed and revised Policies and Procedures.

Dynamically provided Go Live support, including conducting multiple staff

trainings.

Notable Contributions:

< Effectively performed Gap Analysis, reviewing systems functionality

and business processes ensuring a successful conversion. Documented

services and functions.

< Scripting and execution of test stories to test system functionality,

as well as testing of converted data to ensure data integrity and

compliance of systems; incident reporting based on outcome of

implemented test scripts.

< Regression testing.

Account Administrative Representative 1995-1996

Held accountable for processing and developing Medicare enrollments,

disenrollments, and retroactive transaction submission packets to CMS.

Notable Contributions:

< Rendered the highest level of customer service to employer groups and

members; established effective troubleshooting methods to resolve

issues.

< Reconciled plan data with CMS data as well as served as CMS liaison

for all enrollment and disenrollment issues.

Education & Credentials

Bachelor of Science in Business Administration/Information Systems: Sep

1997-Jun 1999

University of Phoenix, San Diego Campus ? San Diego, CA

Certificate of Health Care Compliance (CHC) ( Health Care Compliance

Association

Certified Professional Coder ( American Academy of Professional Coders

Community Emergency Response Team (CERT)

Amateur Radio License KI6NUE

Affiliation & Activity

Volunteer: Large Animal Handler, San Diego Humane Society

- Evacuation of large animals in declared disasters or other situations

requiring emergency response.

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