Manager Insurance

Rekha Rajan

Email: *********@********.***

Address: **** *. ******* ****. **** 1529

City: Tampa

State: FL

Zip: 33602

Country: USA

Phone: 941-***-****

Skill Level: Management

Salary Range: $85,000

Willing to Relocate

Primary Skills/Experience:

See Resume

Educational Background:

See Resume

Job History / Details:

REKHA S. RAJAN, J.D.

1120 E. Kennedy Boulevard, Unit 1529 ~ Tampa, Florida, 33602

941-***-**** (cell) *********@********.***

QUALIFICATIONS

Highly-skilled Healthcare Compliance/Contract Senior Manager with a recent Juris Doctorate degree (2011) and 7+ years of experience with Medicare Advantage companies, contracts and compliance audits. Extensive analytical and organizational capabilities with superior interpersonal and written communication skills. Demonstrated project and team leadership ability and a proven dedication to seeing a project through to its successful conclusion. Technically proficient with Windows 7, MS Office 2010, Apple OS X, Adobe Page Maker, Photoshop and Photo Deluxe. Fluent in English and Tamil. Application to Florida and Missouri Bar pending. Willing to travel.

PROFESSIONAL EXPERIENCE

UNIVERSAL HEALTHCARE, St. Petersburg, Florida 2012 - Present

Medicare Compliance Analyst (Internal Auditor)

* Execute flexible and adaptable risk-based audit plans focusing on areas significant to the Medicare Advantage business segment; collaborate with Compliance Audit team and key executives to develop a compliance audit plan that identifies and prioritizes areas of significant compliance risk.

* Ensure audits deliver high-quality reports and solid conclusions; provide input into the annual audit schedule.

* Manage multiple concurrent audits, process flows and effectiveness of control design; assess the impact of non-conforming results across the audited activity.

* Maintain knowledge of current and proposed laws, regulations and guidelines; evaluate the effectiveness of corrective action plans.

* Track audit plan milestones; interact with internal and external clients and regulators.

SOFTLAW.COM, Tampa and Miami, Florida 2012 - Present

Co-Founder/Chief Operating Officer

* Co-creator of a website to provide free legal information to consumers.

* Match clients with attorney`s based in Florida; manage all marketing and financial activities.

MANASTOTA MEDICAL CORPORATION, Bradenton, Florida 2011 - 2012, 2005 - 2008

Senior Manager (2011 - 2012, 2007 - 2008)

Manager (2006 - 2007)

File Clerk/Business Relationship Development (2005)

* Administered service fund IPA; collaborated with HMO`s on reduced-rate specialist credentialing and introduced the concept of making specialists preferred MAO providers.

* Audited patient records for primary usage of generic medications and ensured PCP`s were aware of MAO formulary changes.

* Increased MRA revenue and verified insurance payments were in line with MRA scores; utilized MRA finding to ensure correct diagnosis code usage.

* Analyzed insurance reports to determine patient services usage and cross-referenced data with PCP records; authored company policies/procedures and implemented a new Audit workplan.

* Negotiated full/partial risk contracts with Medicare Advantage Insurance companies, hospital rates for IPA`s and MRA contract rates; assisted with writing IPA, Specialists and Ancillary Provider contracts.

* Worked with Director and CEO to cultivate new business relationships with PCP's specialists and ancillary providers; developed base contract for HMO`s and Medicare Advantage plans.

* Directed employees involved in developing continuing contractual relationships with HMO`s, hospitals, specialists and ancillary providers.

EDUCATION

FLORIDA COASTAL SCHOOL OF LAW, Jacksonville, Florida

Juris Doctorate (concentration in Medical Malpractice and Health Law Regulations), 2011

UNIVERSITY OF SOUTH FLORIDA, Tampa, Florida

Bachelor of Arts and Sciences in Criminology (minor in History), 2006

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