Kim Greenwood Resume 2016
- 1. Kimberly D. GreenwoodKimberly D. Greenwood 29 Mapes Ave., 2nd Floor • Newark, NJ 07112 (973) 277-6557 • [email protected] PPROFILEROFILE OFOF QQUALIFICATIONSUALIFICATIONS Solutions-focused Health Insurance Professional eager to contribute over 10 years of progressive Medicaid Contract Analyst, Compliance Auditing, Account Management, Research Skills and Customer Service experience within high-volume insurance groups and healthcare facilities. Strong contributor known for establishing effective relationships with regulatory and governmental agencies and distribute statistical data to executive-level management. Excellent communicator who can handle multiple assignments within deadline-driven environments. Key networker among industry professionals with talent for responding to diverse client issues. Ambitious self-starter who demonstrates strong attention-to-detail and sharp analytical and problem-solving skills. Healthcare Attributes: Contributes expertise in various Health Plans (i.e. Medicare, Medicaid), Compliance, Quality Management, Account Management, and Member Service, as well as (MLTSS) Managed Long Term Care Support Services, Disenrollment, Member/ Provider Complaints, Marketing, Internal auditing, Contract agreements, NJ External Quality Review onsite auditing, contract loading, affordable care act. Computer Applications: Proficient in Microsoft Windows 2000, Microsoft Office Suite, SMS, CSP Facets, eGRC, Compliance Portal and Medical Management Systems, Microsoft Excel, Adobe Acrobat X Pro, Microsoft PowerPoint, Internet Explorer, SharePoint and Citrix; willing to learn / master additional programs as necessary. PPROFESSIONALROFESSIONAL EEXPERIENCEXPERIENCE UUNITEDNITEDHHEALTHCAREEALTHCARE®, E®, EDISONDISON, NJ, NJ 2015-P2015-PRESENTRESENT AASSOCSSOC. C. COMPLIANCEOMPLIANCE AANALYSTNALYST Identify compliance contacts/stakeholders to drive compliance program implementation within the business (e.g., compliance committee, oversight structure, business process owners) Collaborate with applicable stakeholders to promote adherence to compliance programs among employees within my scope of influence Develop/implement/facilitate compliance standards, policies, procedures and codes of conduct Develop/implement/facilitate auditing/monitoring processes to identify program issues and help the business address them (e.g., implementation issues, training needs, exceptions to program requirements) Respond to reported compliance issues and develop/facilitate corrective actions as necessary Collaborate with internal/external business partners to help develop and implement effective fraud and abuse detection and reporting programs Drive completion of required compliance training among applicable employee populations Support consistent enforcement of disciplinary standards, collaborating with applicable stakeholders as needed (e.g., Human Capital) Identify industry best practices for compliance programs to determine how our organization compares to other organizations in applicable markets, and identify opportunities for improvement Demonstrate understanding of the impact of applicable laws, regulations, mandates and contracts on our business and operations, including both segment-specific and enterprise-wide implications. Gather and maintain compliance-related data from applicable systems/databases for use in reporting/communications Develop and update compliance scorecards/reports, and communicate to applicable stakeholders (e.g., Key Compliance Indicators) Assist with the day-to-day operations of the department such as ordering supplies, entering expenses, arranging travel for departmental employees and coordinating/scheduling meetings. UUNITEDNITEDHHEALTHCAREEALTHCARE®, E®, EDISONDISON, NJ, NJ 2008-20152008-2015 SSRR. C. COMPLIANCEOMPLIANCE CCOORDINATOROORDINATOR Reviewed and track federal, state, and local government requirements for the medical industry (specifically managed care) to ensure consistent compliance (e.g., CMS, OIG, OSHA) Page 1 of 3
- 2. Developed and present trainings for topic-specific guidelines (e.g., Preparing for an EQRO Site Visit, HIPAA Awareness in Day-to- Day Operations, Understanding Marketing Guidelines)Assisted with the day-to-day operations of the department such as ordering supplies, entering expenses, arranging travel for departmental employees and coordinating/scheduling meetings. Investigated all allegations of non-compliance including HIPAA violations, Fraud, Waste, & Abuse Allegations, Security Breaches. Investigations include researching, interviewing, reporting. Produced and maintain bi-weekly newsletters on Compliance-related issues sent to all employees. Developed trainings and track attestations for annual vendor & contractor compliance. Assisted with department-specific monitoring (i.e., verification of internal processes being completed), assist with clinic preparation of State site visits. Assisted with developing Compliance trainings with other divisions of OptumHealth (e.g., UHN, other Collaborative Care groups) AMERICHOICE OF NJ(A UNITEDHEALTH GROUP CO.), NEWARK, NJ Quality and Operations Project Assistant 2006-2008 Maintained regulatory correspondence which includes scanning, filing and distributing documents in a timely, organized manner and being able to retrieve documents in a timely manner upon request. Monitored member educational and marketing materials for timely submission and approval which included sending materials to the State for review, filing copies and coordinating Spanish translations. Assisted with the day-to-day operations of the department such as ordering supplies, entering expenses, arranging travel for departmental employees and coordinating/scheduling meetings. GENERAL COPIERS INC., RAHWAY, NJ Administrative Assistant 2000-2006 Provided administrative/clerical office support such as typing, filing, greeting visitors, answering/routing phone calls, providing information and scheduling/coordinating appointments, meetings and conferences. Used office automation equipment to prepare correspondence, reports, input data, etc.; coordinated purchases of office equipment, supplies and services; ensuring written materials are complete, accurate and contain correct usage of grammar, spelling, punctuation, and structure; using time management techniques to meet deadlines. Handled various office duties such as: answer phones, filing, type proposals, and memos. Checked meter readings and handle all supply orders for the copier and fax equipment. Prepared and distributed customer invoices and purchase orders. PAGET FREIGHT INC., ELIZABETH, NJ Office Assistant 1998-2000 Performed a variety of clerical, secretarial and administrative tasks in Ocean Freight forwarding for Bermuda. Responsibilities included handling multiple accounts for consolidation shipping to Bermuda, billing/ accounts receivables, as well as insurance and filling. Prepared and distributed customer invoices, purchase orders and other materials. Responsible for bank deposits, tracking invoices and expenses AADDITIONALDDITIONAL JJOBOB HHISTORYISTORY Co-Assistant Manager, ASHLEY STEWART INC., KEARNY, NJ 1996 – 2009 EDUCATION Berkeley College, West Paterson, NJ o Associates of Science Degree in Business Administration, (1996-1998) AREAS OF EXPERTISE Regulatory Quality Clinical Compliance Corporate Compliance Root Cause Analysis Conflict Negotiations Process Improvement Complaint Resolution Audit Medicare Part D Medicaid Grievances References Available Upon Request Page 2 of 3
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