Resume

Sign in

Project Manager Customer Service

Location:
Arlington, VA
Posted:
August 15, 2012

Contact this candidate

Resume:

Tracey Chambers

***** ****** ***** – White Plains, Maryland 20695

Contact: 202-***-**** / Email: v3hsai@r.postjobfree.com

PROFESSIONAL EXPERIENCE

Blue Cross Blue Shield Association, Washington, DC 03/2009 – Present

Investigator, Danielle Robertson, 202-***-****

• Supervise and advise subordinate personnel throughout assigned investigative processes

• Coordinate and delegate administrative and investigative tasks for subordinate personnel

• Electronically approve T&E and Unit financial reimbursements

• Develops, manage, and refer case notifications to OPM OIG

• Establish and manage electronic fraud case and financial files

• Execute restitution payments from federal employees and providers

• Manage and recommend changes to the medical policy and FEP SIU manuals

• Demonstrated knowledge and skill in statistical analysis, principles, and procedures for case preparation utilizing online investigative resources, such as, Accurint, McSource, and StarSentinal

• Manage investigations related to fraud, waste, and abuse committed by federal employees

• Demonstrated ability to independently compose case reports for internal/external referrals related to fraud, waste, and abused related crimes

• Perform complex data analyses to determine the Program’s financial losses

• SME and liaison for all FEP Debarment related issues governing OPM OIG and BCBS FEP policies, procedures, and operations

• Thorough skill and knowledge of utilizing methods to evaluate and measure proper systems to accomplish OPM’s goals

• Demonstrated skill in obtaining testimonial and documentary evidence from witnesses and suspects

• Participate in Case Management (CM) task force meetings with variety of LE agencies

• Coordinate and execute hotline referrals/complaints for administrative actions

• Ability to effectively communicate orally and in written form in a clear and concise manner with management, internal/external customers, local, state, and federal LE agencies

• Utilize PeopleSoft to process budget request utilizing the SPI system for Plan reimbursements utilizing automated and tracking systems

• Recommend investigative cases to OIG and other LE agencies in written form

• Sound knowledge of local, state, federal agencies, and FBI operations, roles and missions in order to direct appropriate protocols, fraud and abuse measures

Blue Cross Blue Shield Association, Washington, DC 02/2007 – 03/2009

Investigative Analyst, Danielle Robertson 202-***-****

• Researched and analyzed pharmaceutical/medical claims using Accurint, McSource, and StarSentinal essential in developing case materials

• Supported Privacy Compliance Officer and high impacted privacy incidents related to investigations

• Provided analytical and technical support that included data retrieval and research

• Independently created, organized and maintained spreadsheets to track medical data

• Analyzed data to determine Program financial losses

• Manage an electronic case file

• Independently updated financial statements and statistical reports utilizing PeopleSoft

• Facilitated and processed claims data requested identified by LE agencies

• Reviewed Compliance and Privacy policies and e-Compliance results

• Independently, reviewed and analyzed complex and sensitive investigative activities

• Analyzed evidentiary materials for preparation of fraud and abuse investigations

• Managed the Term Death Project by organizing extensive research methods

• Performed preliminary background and research on a variety of pharmacy/medical cases

• Searched investigative databases for evidentiary material for written summaries

Blue Cross Blue Shield Association, Washington, DC 10/2003 – 02/2007

Project Manager, Virginia McDonald 202-***-****

• Developed and organized Managing/Medical director’ meeting agendas and electronic calendars

• Established and managed electronic databases for correspondence tracking

• Prepared agendas and other documentation for management meetings

• Reviewed and edited meeting notes

• Independently communicated electronically for follow up and tracking purposes

• Prepared correspondence, reports, form letters, and other related documents

• Proofread and edited case management (CM) manuals and monthly memos, for accuracy

• Published CM documentation and user guides to Plan contacts

• Managed appointments, conferences and conference materials for the department

• Acted as liaison between Plan contacts, facilities and vendors

• Supervised temporary employees

• Maintained vendor database including managing vendor quotes and invoices

• Provided acquisition procurement support through procurement planning

• Tracked and monitored procurement statuses ensuring timelines are met

• Utilized financial management software to execute budgeted information and other related requisitions

• Managed travel for upper management according to OMP’s policies and procedures

• Independently created and updated electronic web-based pages

• Approved enhancements as program administrator for the CM Reporting System (CMRS) and Medical Policy Benefit Assistant Tracking System (BATS)

• Developed and analyzed quantitative work methods and procedures to the CM program

• Maintained and managed efficient practices related to records retention

• Managed FEP Plan Linker and CM programs to maintain departmental compliance

• Independently managed CM and Medical Benefit policies and procedures manuals

• Analyzed and managed specific financial and statistical reporting procedures

• Served as a business advisor to the Facilities department regarding procurement services

Medical Faculty Associates, Washington, DC 01/1998 – 10/2003

Compliance Specialist, Carolyn Bell 202-***-****

• Managed a range of safety and occupational health practices and procedural guidelines

• Developed, negotiated, and analyzed Program safety procedures to prevent health hazards

• Conducted building inspections to determine work practices and facility operations

• Conducted investigations to determine health hazards to prevent substantial hazards according to Occupational Safety Health Administration (OSHA)

• Managed data management system of internal exposures and employee complaints

• Conducted and managed surveys and work related injuries to determine adequacy and use of protective equipment preventing work-related injuries

• Effectively communicated verbally and in written form when preparing reports

• Investigated and analyzed potential hazardous practices for remedial actions

• Served as liaison for all OSHA related audits

Children’s National Medical Center, Washington, DC 01/1997 – 01/1998

Administrative Assistant II, Celeste Favor 202-***-****

• Liaison for parents and family members concerning neurological services

• Coordinated Epilepsy Program activities by maintaining a spreadsheet database

• Managed on-call schedules for attending physicians, rotating fellows and residents

• Obtained pre-certification from insurance companies for hospital admissions

• Managed monthly financial statements for department to maintain checks and balances

GMAC/Residential Funding Corporation, Bethesda, Maryland 01/1994 – 01/1997

Loan Officer Specialist, Kay Knoll 301-***-****

• Independently analyzed processed financial applications

• Provided effective customer service by responding to inquiries concerning member loans

• Analyzed loan documents ensuring compliance based on lending principles and standards

• Effectively communicated verbally and in written form with in/external customers

• Maintained integrity by protecting confidential information and bank developments

• Independently managed travel expenses and other departmental expenses

• Managed the Market Pipeline report to track daily banking updates

EDUCATION

• University of M.D. University College, Adelphi, MD – B.S. Criminal Justice, Graduate 2012

MEMBERSHIPS and AFFILIATIONS

• National Healthcare Anti-Fraud Association (NHCAA)

• Criminal Justice Public Administration Club (UMUC)

RELATED JOB TRAINING and AWARDS

National Healthcare Anti-Fraud Association (NHCAA)

• BCBS of TX Advanced Investigators

• Reid’s Interviewing Techniques

• Fraud Skills and Schemes, Part I/II

• Best Investigative Practices

• Data Analytics and Technology

• Fundamentals of Investigations

• Advanced Interviewing Techniques using Statement Analysis

OFFICE SKILLS

• Advanced skills with MS Word, Excel, PowerPoint, Outlook, and Access

• Working knowledge of PeopleSoft (Financial Management Online System)

• Knowledgeable in diversity and related practices

• Strong analytical and problem-solving skills

• Demonstrated ability to plan and organize

VOLUNTEER

Presidential Campaign 2012

Emergency Response Team (BCBSA) 2011-present

References Available Upon Request



Contact this candidate