Compliance Analyst Resume Newark, NJ - Hire IT People

SUMMARY:

To obtain a position within the company in which my special training skills will be utilized and grow.

WORK EXPERIENCE:

Confidential, Newark, NJ

Compliance Analyst

Responsibilities:

Conduct several Mandate and Non - Mandate compliance audits per year, documenting and reporting findings to prospective areas
Tracking and managing compliance issues
Developing, documenting and tracking corrective action plans to address non-compliant areas
Working with Service Managers and staff to ensure understanding of Mandates and other audit issues
Review, revise and/or approve Mandate documentation for Desk Level to ensure correct information is being documented to OLI
Compliance liaison between Internal Audit and Service
Reviewing and scrubbing exceptions before they are sent to the Service Division.
Dispute Internal audit findings when necessary, until agreement has been met.
Creating and distributing the weekly and monthly “Prompt Pay” reports

Business Analyst

Confidential

Responsibilities:

Conducted research and root cause analysis for the department with the goal of recommending and implementing new processes to improve operational performance. Provided technical support
Liaison with IS for new system enhancements.
05/00-06/03 Institutional Claims & Correspondence Specialist
Processed Managed Care facility claims on the HSII and Qblue system.
Responded in writing to facilities with inquiries regarding claim and benefit issues.
10/98- 05/00 Member Service Coordinator (Medicare Blue)
Resolved member and provider benefit, enrollment and claim issues
Provided information to company representatives regarding operational concerns.
Investigated and documented executive inquiries
Communicated in writing the results of reviews to members, providers, manager etc...
Prepared timely operational reports, monitored inventory levels to ensure the accomplishment of departmental as well as divisional goals.

Confidential

Liaison & Trainer

Responsibilities:

Created and administered workflows for team.
Trained new and existing employees.
Responsible for all members’ prescription issues being resolved in a timely manner.
Trainer for Confidential System

Confidential, Elizabeth, NJ

Customer Service Representative

Responsibilities:

Confidential, Linden, NJ

Assistant Bookkeeper

Responsibilities:

Responsible for A/P, processing invoices, data entry, disbursements, check printing and matching, and posting and monthly closing, heavy vendor contact. A/R, billing, sales entry, cash receipts, bank reconciliation, posting, end of month closing and statement printing.