Rae Langston

Corporate Management and Creative Leadership

Contact

215-***-****

adv3si@r.postjobfree.com

www.linkedin.com/in/rae-langston19148

Summary

Offering over 15 years of leadership experience in various roles including healthcare fraud, data management, and strategic/operational risk management. I specialize in program development and issue resolution, driving improvements through innovation and leadership.

Education

MBF Institute, 2022

Life Coach/Mind-Body Practitioner

Strayer University, 2007

Medical Billing/Coding Specialist

Healthcare Administration

Chubb Institute, 2000

Technical Support Specialist

Experience

2016-2022

Risk Management • ERM • AmeriHealth Caritas

Developed Enterprise Risk Management practices, tools, and policies to report, analyze, and manage enterprise risks.

Designed programs and protocols to identify, monitor and control risk exposure across 15 organizational lines of business in addition to all corporate functions.

Organized and managed results-oriented teams in program management, process improvement and development, as well as issue management to minimize loss and adverse financial impact.

Development and ownership of risk reporting including mitigation strategies to Senior Executives, C-Suite, Parent Companies and Board of Directors.

Development and delivery of educational documents on Risk Management framework, methodologies, tools, and P&Ps.

Training of business leaders on risk methodologies and provided training on how to foster a risk- conscious culture across multiple lines of business and a variety of audiences.

Risk management systems (RSA Archer) implementation, design, and development across multiple departmental user groups.

2015-2016

Manager Data Analytics • SIU/Program Integrity • AmeriHealth Caritas

Managed and recruited staff supporting all data analytical aspects of the end-to-end investigative process across a multi-organizational matrix within the managed care realm.

Oversaw contractual compliance and Fraud, Waste, and Abuse (FWA) activities across 8 state Medicaid contracts and served as a key contributor during CMS and DHS audits.

Led implementation activities for onboarding new state contracts, ensuring successful and timely implementation of FWA activities.

Coordinated preparation and delivery of all FWA reporting to internal departments, contracted lines of business as well as state and federal oversight agencies.

Built work schedules and staff assignments, taking workload, space, and equipment availability into consideration.

Planned and implemented programs for corporate and operational supporting personnel including administration and training.

Served as a subject matter expert in governmental programs.

2013-2015

Technical Team Lead • Program Integrity • AmeriHealth Caritas

Managed large scale projects across a complex organizational matrix including the integration of resources, outlining project requirements, introducing new concepts and processes, and driving completion of deliverables to ensure success.

Designed, implemented, and owned fraud prevention processes across an enterprise of companies both under ten months of leading beginning to operational (e.g., Prepayment Review, Sanction Provider and Member Service Verification processes)

Served as point of contact for contract negotiations of vendor services and project business owner with vendors.

Developed enhancements to the Program Integrity framework, policy creation, and system (FACETS) upgrades.

Established and implemented policies and procedures to support all state and federal contractual regulatory requirements, KPI metric reporting, and the design and implementations of the FWA software and case tracking tool STARS Solution Suite.

Systems

FACETS

MACESS

RSA Archer

STARS Solution Suite

Microsoft Office

IMAX

SQL Server

BI Solutions & Reporting

Zoom

Teams

SharePoint

Accomplishments

Exceptional reputation for delivering on objectives and outstanding performance in strategic and operational process planning and business process engineering.

Demonstrated success as an effective implementer with ability to create and communicate vision as well as re-engineered processes and programs to achieve efficiency and sustainability.

Created highly effective new programs that significantly impacted efficiency and improved operations.

Recognized in three different roles as an exceptional employee for outstanding performance and team contributions.

Routinely served as a concurrent business owner on multiple large-scale projects with the ability to ensure success and completion ahead of schedule.

Key Skills

Governmental Healthcare Systems: Regulatory Requirements, Risk and Compliance Management, Claims Payment, CMS/DHS Audits

Corporate Business Functions: Program Development, Project Management, New Business Implementation, Vendor Management, System Development/Implementation/Management

Leadership: Training and Development, Team Leadership, Behavior Modeling, Mentoring/Coaching

References

[Available upon request.]

Contact this candidate