Risk Adjustment Audit Project Manager at EY / Optum (2025-08 – Present)
Led and coordinated a high-performing audit team on a Risk Adjustment project, overseeing operations, staff training, and quality assurance while ensuring full HIPAA compliance and adherence to regulatory standards.
- Led and coordinated a high-performing audit team on a Risk Adjustment project, overseeing operations, staff training, and quality assurance while ensuring full HIPAA compliance and adherence to regulatory standards.
- Conducted comprehensive medical record reviews, analyzing clinical documentation to validate diagnosis accuracy and support proper ICD-10-CM coding aligned with CMS risk adjustment guidelines.
- Performed RADV compliance audits, identifying documentation gaps and ensuring all records met federal and state regulatory requirements for risk adjustment validation.
- Evaluated supporting clinical documentation including lab results, radiology reports, provider notes, and treatment plans to confirm the accuracy and specificity of reported diagnoses.
- Produced detailed audit reports and data analyses, tracking findings in databases, verifying provider NPI credentials, and delivering actionable recommendations to improve coding accuracy and operational efficiency.
Compliance Specialist at Dept. of Veteran Affairs (2025-02 – 2025-04)
Monitored and enforced compliance with federal regulations and internal policies for veteran assistance programs, including Emergency Housing Assistance (EHA) and Supportive Services for Veteran Families (SSVF).
- Monitored and enforced compliance with federal regulations and internal policies for veteran assistance programs, including Emergency Housing Assistance (EHA) and Supportive Services for Veteran Families (SSVF).
- Conducted detailed compliance audits and documentation reviews, verifying required signatures, eligibility criteria, and supporting records to ensure accurate processing of housing assistance reimbursements.
- Reviewed contracts, leases, and financial documentation to identify discrepancies, deficiencies, and compliance risks, ensuring adherence to regulatory and program requirements.
- Coordinated cross-departmental communication and collaborated with leadership teams to address regulatory concerns, policy updates, and compliance improvement initiatives.
- Maintained comprehensive audit records, compliance reports, and risk assessments, providing recommendations that strengthened internal controls and improved operational efficiency.
Director of Client Relations, Case Manager at Justice Tax, LLC (2023-12 – 2025-01)
Directed client relations and tax resolution operations, managing complex IRS tax resolution cases, reviewing tax transcripts, preparing financial documentation, and negotiating agreements to resolve client liabilities.
- Directed client relations and tax resolution operations, managing complex IRS tax resolution cases, reviewing tax transcripts, preparing financial documentation, and negotiating agreements to resolve client liabilities.
- Led the Client Relations department, resolving escalated complaints, conducting case reviews with corporate counsel, and authorizing contract-based refunds while ensuring compliance with consumer protection regulations.
- Built and maintained long-term client relationships through proactive communication, strategic account management, and personalized service, consistently improving client satisfaction, retention, and loyalty.
- Trained and mentored case managers on conflict resolution, case management procedures, and client engagement best practices, strengthening team performance and service quality.
- Implemented CRM systems, feedback programs, and cross-department communication strategies that improved case tracking, operational efficiency, and timely resolution of client issues.
Legal Assistant/Case Manager Supervisor & Adjuster at Eckert & Associates, P.A. (2019-01 – 2024-10)
Supervised a team of case managers while overseeing insurance liability, commercial liability, subrogation, mitigation, arbitration, and global settlement cases, ensuring accurate case handling and timely resolution.
- Supervised a team of case managers while overseeing insurance liability, commercial liability, subrogation, mitigation, arbitration, and global settlement cases, ensuring accurate case handling and timely resolution.
- Acted as a key liaison between attorneys, clients, forensic accountants, and opposing counsel, coordinating case strategy, reviewing financial reports, and facilitating efficient communication across stakeholders.
- Managed complex legal case files and documentation using case management systems, ensuring compliance with legal standards, maintaining confidentiality, and preparing court filings, exhibits, and transactional documents.
- Negotiated with insurance companies and external parties to resolve claims, secure settlements, and support litigation preparation through legal research, evidence organization, and witness coordination.
- Trained, mentored, and evaluated case managers and new staff, implementing workflow improvements and training programs that increased team productivity, case accuracy, and operational efficiency.
Team Leader/Supervisor at Medcom Benefit Solutions (2011-10 – 2016-02)
Supervised and led a team of 15 employees, managing daily operations, delegating tasks, and providing training to improve performance, productivity, and service quality.
- Supervised and led a team of 15 employees, managing daily operations, delegating tasks, and providing training to improve performance, productivity, and service quality.
- Ensured strict compliance with HIPAA regulations and tax information security standards while processing confidential customer data and managing access to medical benefit accounts.
- Oversaw appeals for medical claims, issued and reissued benefit checks and cards, and conducted file and document audits to maintain accuracy and regulatory compliance.
- Developed and implemented operational strategies that improved workflow efficiency, customer satisfaction, and interdepartmental collaboration.
- Produced detailed monthly performance and operational reports, analyzed service metrics, and implemented process improvements to enhance team effectiveness and client service delivery.
