Senior Regulatory Compliance Specialist Resume Philadelphia, PA - Hire IT People

SUMMARY:

Over 13+ years of progressive regulatory affairs, corporate compliance, B2C/B2B marketing and healthcare communications experience and expertise.

AREA OF EXPERTISE

New Business Implementation
Project Management
Writing, Editing and Production
Regulatory & Government Affairs
Policy Research
Metric & Trend Identification
Website Development
Product Distribution
Risk Analysis
Process Improvement

PROFESSIONAL EXPERIENCE:

Confidential, Philadelphia, PA

Senior Regulatory Compliance Specialist

Lead pre - delegation audit and continued monitoring of first tier, downstream and related entities to ensure the seven elements of compliance are currently or will be effectively implemented to reduce organizational risk and to ensure FWA provisions and Stark Law prohibition and statutes are enforced
Chaired learning & development activities to implement meticulous training programs to ensure business units with Medicare LOB touchpoints are aware of federal and state regulations are implemented into policies, procedures, and desktop guides
Team lead of benefit review to ensure bid proposal information aligns with organizational intent and regulatory requirements
Coordinated and presented tracer presentation to CMS audit officials during onsite 2016 Medicare Program Audit - no issues or findings identified
Researches new and existing Medicare Parts C & D policy and HPMS memorandums and coordinating with appropriate business units to implement changes - additionally provides recommendations for best practices based on industry success and identifies areas of opportunity for process improvement
Monitor and analyze key compliance risk areas in various business departments, provide assessments to management, and coordinate with business units to mitigate risk due to new policy, identified deficiency, etc.
Key contributor of SharePoint workgroup to buildout Medicare Compliance SharePoint sites to track and document risk items, marketing materials, and HPMS and state guidance to ensure proper monitoring and compliance issues are addressed
Headed manual review of annual materials (ANOC/EOC/Summary of Benefits) to ensure they adhere to approved bid information and template guidelines. Manages review and submission for 4 distinct Medicare products (Basic, D-SNP, 2 value-based plans)
Assist Marketing & Communications department in the creation of member, provider, and marketing material 3/19
Team member of various cost-saving and strategic initiatives workgroups specific to identify and triage opportunities specific to the Medicare line of business.
Leading review manager of all Provider Communication & Marketing material to ensure content adheres to organizational standards and regulatory guidance is effectively communicated to the provider network
Direct best practice communications guidance to all audit and regulatory presentations to senior management, board of directors, and regulatory entities (CMS, DHS, etc.)
Collaborate with management and the Medicare Compliance Audit team with audits and comprehensive corrective action request to effectively improve performance, and identify trends, deficiencies and best practices

Marketing Communications Specialist

Launched provider network recruiting effort - marketing material for Medicaid and Medicare lines of business moving into new territories. Recruiting, contracting & marketing efforts led to 31.6% increase in provider network size
Proof and edit all provider communication materials distributed externally
Counseled provider network management on best communication practices to effectively deliver messages
Created new platform and creative lead for bi-monthly provider newsletter delivered to over 11,700 subscribers
Create organizational website material to increase and maintain consumer and provider engagement across three lines of business
Served as primary Corporate Communications liaison to provider network management
Develop talking points for C-suite executives for internal and external engagements
Create and contribute internal communications articles posted on employee website

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Senior Regulatory Compliance Specialist Resume

Philadelphia, PA

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