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Work Background
StrategyGen Co. (SBA Certified HUBZone Small Business)Compliance Reviewer
Feb. 2025 - Oct. 2025
StrategyGenReviewer
Feb. 2025 - Oct. 2025Conducted compliance reviews and audits in alignment with CMS and federal regulations for Qualified Health Plan (QHP) Issuers.
Researched and analyzed regulatory updates to ensure testing and procedures remained current and accurate.
Documented findings and prepared detailed reports and exhibit for federal and internal stakeholders.
Modified audit software and documentation to reflect finalized reports and government edits.
Developed compliance review protocols and outreach guidelines to support nursing home documentation audits.
Maintained comprehensive project deliverables and ensured all audit timelines and quality standards were met.
Capital Blue CrossCompliance Analyst
Feb. 2022 - Feb. 2025Harrisburg, Pennsylvania, United StatesAs a Compliance Analyst at Capital Blue Cross, I manage searches of prospective employees and providers against state and federal preclusion and exclusion lists, streamline processes by developing efficient workflows, and collaborate with management to ensure compliance deadlines are met. Additionally, I present reports on healthcare compliance topics, implement and review departmental policies and procedures, and conduct work focused on Medicare compliance by analyzing and applying current CMS rules and regulations to policies and procedures.
The Pennsylvania Department of Human ServicesHealth Information Technology Communications Director
Oct. 2020 - Dec. 2021Harrisburg, Pennsylvania, United StatesIn my role as the Health Information Technology Communications Director at The Pennsylvania Department of Human Services, I led the creation and dissemination of bi-weekly newsletters to over 3,500 medical providers, ensuring they were informed about key updates on Medicare and Promoting Interoperability programs. Additionally, I conducted a comprehensive needs assessment through a state-wide survey of over 150,000 medical providers, synthesizing data for publication on the department website. I also coordinated training webinars for 15-20 medical providers, crafting slide decks, policy documents, and registration processes, and ensured timely Medicaid claim processing through daily and weekly reporting, contributing to improved billing cycle efficiency.
Pennsylvania Department of Human ServicesDirector Information Technology Communications
Oct. 2020 - Dec. 2021Camp Hill, Pennsylvania, United States· Led the creation and dissemination of bi-weekly newsletters to 3,500+ medical providers, ensuring key updates on Medicare and Promoting Interoperability programs.
· Conducted a comprehensive needs assessment via a state-wide survey of 150,000+ medical providers, synthesizing data for publication on the department website.
· Coordinated training webinars for 15-20 medical providers, crafting slide decks, policy documents, and registration processes.
· Ensured timely Medicaid claim processing through daily and weekly reporting, contributing to improved billing cycle efficiency.
· Updated policies and procedures; training document and the Pennsylvania Department of Human Services website for providers and their staff concerning state and federal guidelines for the Promoting Interoperability Program
Pennsylvania Department of Human ServicesTechnical Director
Oct. 2020 - Dec. 2021Directed communication initiatives for over 3,500 medical providers, including biweekly newsletters and program updates.
Conducted a statewide survey of 150,000+ providers to assess program needs and enhance public reporting.
Coordinated and led training webinars for medical providers, developing educational materials and policies.
Updated departmental policies, procedures, and website content to ensure compliance with federal and state healthcare regulations.
Streamlined Medicaid claim reporting, contributing to improved billing and payment cycle efficiency.
UPMCService Coordinator Associate
Oct. 2019 - Oct. 2020In my role as a Service Coordinator Associate at UPMC, I assisted in managing the Community Health Choices program, helping Medicaid-eligible seniors access vital home and community-based services. I developed and delivered training materials for statewide adoption, enhancing program impact and training consistency. Additionally, I managed client inquiries and applications, ensuring timely and accurate processing of participant services.
UPMCService Coordinator
Oct. 2019 - Oct. 2020Supported provider and member relations through compliance-focused communication and process documentation.
Developed internal policies and workflows to improve member service coordination and reporting accuracy.
Collaborated with interdisciplinary teams to address member needs and maintain adherence to quality standards.
Highmark HealthMember Services Associate
Nov. 2018 - Oct. 2019Camp Hill, Pennsylvania, United StatesIn my role as a Member Services Associate at Highmark Health in Camp Hill, Pennsylvania, I analyzed policies and procedures to effectively respond to member inquiries regarding medical benefits, claims, and pharmacy services. I was recognized for exceptional service by identifying and resolving a billing discrepancy, saving a client thousands of dollars in medical costs. I processed inbound calls, swiftly addressing billing and claims concerns, and directed members to the appropriate authorities for resolution, improving customer satisfaction and reducing call escalations.
HighmarkMembership Services Coordinator
Nov. 2018 - Oct. 2019Provided direct support to members and providers regarding benefits, claims, and eligibility.
Assisted in developing standard operating procedures and training resources for team use.
Ensured service excellence through accurate documentation and adherence to compliance requirements.
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