Senior Administrator Call Center

TAKIYAH TURNER

Mount Juliet, TN *****

615-***-**** *.*.************@*****.***

PROFESSIONAL SUMMARY

Savvy Compliance Analyst with a four-year history of advising companies on compliance and policy development. Communicated efficiently in person and in writing to inform the company of legal requirements., Detail-oriented team player with strong organizational skills. Ability to handle multiple projects simultaneously with a high degree of accuracy. Organized and dependable candidate successful at managing multiple priorities with a positive attitude. Willingness to take on added responsibilities to meet team goals.

SKILLS

Regulatory compliance Quality assurance Vendor management Audit/monitoring Healthcare law Risk management

Relationship-building Contract negotiations Client Engagement WORK HISTORY

09/2016 to 06/2020 Senior Legal Compliance Advisor Cigna – Nashville, TN

Healthcare Audits to ensure all audit/monitoring performed aligned with regulatory, state, federal, and plan requirements and standards.

Initiated corrective action plans (CAPS) based on audit/monitoring outcomes Managed high-profile clients, processing complex reports and workloads. Created spreadsheets using Microsoft Excel for daily, weekly, and monthly reporting

Collaborated with team members to achieve target results

Conducted research, gathered information from multiple sources, and presented results.

10/2006 to 09/2016 Senior Administrator TN Quest – Nashville, TN

Collaborated with providers and Centers for Medicare & Medicaid Services

Responsible for negotiating, managing, renewing, and market contracting in the Independent Physician Association arena.

Ensured contract proposal and fee schedules were within target/budget guidelines while maintaining competitiveness in region/territory.

Performed onsite delegated credentialing audits and provided documented feedback.

Utilization Management and Communication and Leadership Awards.

Led and assessed all onsite pre-delegation and annual compliance assessment audits.

Responsible for negotiating, managing, renewing, and market contracting in the arena of medical groups and Independent Practice Associates

(IPAs).

TAKIYAH TURNER

Mount Juliet, TN 37122

615-***-**** *.*.************@*****.***

Ensured contract proposal and fee schedules were within target/budget guidelines while maintaining competitiveness in region/territory.

Networked with industry professionals to exchange best practice knowledge and stay abreast of the latest developments.

Responded to, researched, and resolved issues from internal staff, external departments, and customers.

Led and assessed delegation oversight readiness based on NCQA, HHSC, CMS, TDI, and health plan standards for the delegated function of Claims Administration, Call Center, and Credentialing. EDUCATION

Bachelor of Science: Psychology Tennessee State University - Nashville, TN CERTIFICATES / LICENSES

Quinnipiac University Hamden, CT Legal Compliance Certificate Life Insurance Producer, License

Pre-Need Agent, License

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