Project Manager Risk Management

Chris Williams

****************@*****.*** • 336-***-****

LinkedIn Profile • Hyattsville, MD

Detail-oriented professional proficient in enforcing policies and ensuring adherence to industry regulations. Skilled in compliance initiatives, risk management, audits, and investigations. Adept at establishing solid and trustworthy relationships with regulatory bodies and stakeholders. Strong analytical skills to interpret complex regulations and provide strategic compliance solutions. Exceptional communication skills to convey compliance information at key organizational levels. Excels in leading and motivating cross-functional teams to achieve compliance objectives. Committed to ethical standards and cultivating a culture of compliance, driving continuous improvement in processes and procedures.

Areas of Expertise

Regulatory Compliance

Issue & Risk Mitigation

Cost Optimization

Process Improvements

Team Leadership & Training

Project & Program Management

Written & Oral Communication

Reports & Documentation

Audits & Assessments

Stakeholder Relations

Research & Analysis

Policies & Procedures

Professional Experience

Sr. Project Manager 11/2022 to Present

CareFirst BlueCross BlueShield Community Health Plan District of Columbia

Spearhead the development and solidifying of valuable relationships with BH providers to cultivate a robust, cost-effective BH network. Lead as the main point of contact for the DC Medicaid BH network, offering insights on recruitment strategies, network expansion, and overseeing contracting and credentialing matters in collaboration with PR Reps and internal support teams. Initiate the development of BH provider training materials, manuals, and quick reference guides for CHPDC to prepare for Readiness Reviews and contract maintenance. Facilitate practitioner and facility orientations on CHPDC protocols, working with PR Reps for continuous training and site visits to ensure provider excellence and guideline adherence.

Coordinate with corporate and CHPDC departments to ensure BH provider contracting, credentialing, and onboarding align with NCQA guidelines, federal mandates, and District of Columbia regulations for DHCF contract adherence.

●Liaise with diverse BH professionals including Psychiatrists, Psychologists, MHNP, LCPC, LPC, and Substance Use Disorder treatment providers to resolve issues and handle provider escalations effectively.

●Oversee the provider relations inbox, recognizing and resolving credentialing, contracting, claims, and other provider-related inquiries to enable operational efficiency.

●Analyze and propose solutions for BH contract disputes, complex billing questions, non-routine claim issues, and other intricate matters within the BH network, working closely with the Claims Department for resolution.

●Collaborated with the Provider Education Department to design training sessions for portal access, behavioral health prior authorizations, and other crucial topics for CareFirst CHPDC enrollees.

●Successfully completed the onboarding of behavioral providers to our network.

●Diligently served as a people leader to a team of associates.

Consultant Embedded Compliance 06/2013 to 11/2022

CareFirst BlueCross BlueShield Community Health Plan District of Columbia

Achieved compliance goals by training, scheduling, and guiding auditors to meet necessary standards. Followed production, productivity, quality, and customer-service standards, resolving operational problems and pinpointing work process improvements. Implemented a "Compliance Monitoring List" with 70 items to track companywide requirements regularly. Monitored expenses and introduced cost-saving measures to meet cost standards. Prepared for audits by researching materials and conceptualizing action plans. Validated assets and liabilities data by comparing items to documentation. Documented audit tests and findings in work papers and memorandums.

●Prepared and submitted monthly regulatory reports to comply with regulatory requirements. Coordinated recovery of overpayments from various program integrity activities such as audits, investigations, data mining, and collections. Conducted 104 audits saving $411,953.37 in FY 2022.

●Developed processes for seamless collaboration with Business Owners to maintain up-to-date policies and mitigate penalties, corrective action plans, and sanctions, including termination of contracts.

●Ensured compliance with regulations by examining records, reports, operating practices, and documentation, while recommending internal control improvements.

●Coordinated with external auditors and facilitated successful audit meetings with no identified issues.

●Compiled management reports by gathering, analyzing, and summarizing information for the Chief Compliance Officer.

●Stayed up-to-date with the industry changes through ongoing education, reading professional publications, building networks, and enrolling in professional organizations.

●Strengthened the compliance department's reputation by embracing new challenges and seeking opportunities to deliver value through timely communication, meeting deadlines, and providing guidance.

Education

Carrington College – Phoenix

Bachelor of Science – Health Care Management - Degree

North Carolina Agricultural and Technical State University

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