Quality Assurance Regulatory Compliance

DORCAS HAYNES

Cell: 314-***-****

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

www.linkedin.com/Dorcas-Haynes

HEALTHCARE QUALITY ASSURANCE ANALYST

Benefit Specialist with experience in monitoring, auditing, and analyzing health care processes to ensure compliance with industry standards and regulations. Proficient in conducting detailed quality assessments, identifying process improvement opportunities, and ensuring adherence to health care policies. Self-motivated, with excellent interpersonal skills. Takes full ownership of assignments and can multitask. Able to work under pressure of time constraints. Work well with minimal supervision, independently and as a team member. Strong analytical skills with a focus on enhancing patient care, reducing risks, and improving operational efficiency. Experienced in collaborating with cross-functional teams to implement corrective action plans and deliver high-quality healthcare services.

Areas of Expertise

Quality Auditing Regulatory Compliance Data Analysis Process Improvement

Risk Management Healthcare Reporting Cross-Functional Collaboration Software Proficiency

Vendor Relationships Customer Service

CIGNA/EXPRESS SCRIPTS – St. Louis, Missouri

November 2020 – October 2024

Quality Review and Audit Analyst (Remote)

Interface with the pharmaceutical manufacturer in the Enterprise Print & Delivery Department

Provided critical reviews of production data and letters and gave feedback on errors to business partners and collaborated to resolve issues in a timely manner.

Engaged in Quality Assurance, reviewing letters and releasing records for running and afternoon file transfer protocol (FTP upload.

Used multiple digital and electronic tools to perform daily tasks such as Microsoft Office, Oracle SQL Developer, and Intervention Router.

Completed reviews of test-case audits and communication to ensure that requirements were met according to the specified criteria. Additionally, provided feedback to business partners on essential updates to drive consistency and accuracy.

AMPCUS INC – Chantilly, Virginia

May 2020 – November 2020

Contract Analyst for Cigna/Express Scripts (Remote)

Hired as a full-time employee of Cigna/Express Scripts, serving as a Quality Review and Audit Analyst working with the pharmaceutical manufacturer.

Working in the Enterprise Print & Delivery Department, provided critical quality reviews of production data and letters and giving feedback on errors to business partners and collaborated to resolve issues in a timely manner.

Prioritized Quality Assurance efforts, reviewing letters and releasing records for morning and afternoon file transfer protocol (FTP) upload.

Used multiple digital and electronic tools to perform daily tasks such as Microsoft Office, Oracle SQL Developer, and Intervention Router.

ADDITIONAL EXPERIENCE

LUTHERAN CHURCH MO SYNOD/CONCORDIA PLAN SERVICES– St. Louis, Missouri

January 2006 – July 2018

Senior Team Lead of Health Benefits

Served as the primary point of contact for employers, employees, and health vendors for a non-profit organization, addressing all inquiries and issues related to health benefits. Facilitated effective communication to ensure clarity and resolution of health benefit matters, enhancing overall satisfaction and organizational efficiency.

Managed the daily operation of Health Benefit Services which included administering health benefit programs. (medical, dental, prescription, mental health, vision, and Medicare Supplement)

Oversaw enrollment processes, member appeals, review of claim payments, personal spending accounts, escalated claim issues and COBRA benefit.

Conduct benefits orientations for new employees, represented the organization at benefit fairs and conventions, and open enrollment presentations.

Served as the Subject Matter Expert for Medicare.

Partnered with multiple stakeholders and business unit leadership to establish operational objectives and procedures ensuring compliance with CMS guidelines.

Assisted in reviewing processes and proposing changes or enhancement to achieve benefit solutions with the Marketing, Communications, and Legal Team.

As the Senior Team Lead, conducted performance reviews for the health benefit team, providing feedback and guidance to enhance team effectiveness.

Maintained and facilitated a confidential atmosphere in handling sensitive health benefit information.

LUTHERAN CHURCH MO SYNOD – St. Louis, Missouri

April 1986 – December 2015

Health Benefit Specialist

Managed Care Representative

Enrollment Service Specialist

EDUCATION

Bachelor of Science (BS) in Healthcare Management

Concordia University Wisconsin - St. Louis, Missouri

Technical Skills

Proficient in MS Office - Outlook, Word, Excel, and PowerPoint

Ad hoc network

HRIS Systems: Lawson and PeopleSoft

Oracle SQL

Jira

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