Angela Compton
Matthews,NC
Summary
Detail-oriented Healthcare Operations and Compliance Analyst with expertise in Medicaid and Medicare processes, TPA coordination, and contract compliance. Proven ability to enhance claims accuracy, resolve provider issues, and analyze operational data to strengthen provider networks. Committed to fostering relationships that improve network quality and member experience while ensuring regulatory compliance.
Overview
5
5
years of professional experience
Work History
Health Plan Compliance Analyst - CarePartners PACE
HCA Healthcare
, NC
01.2024 - Current
- Coordinated contracting activities and onboarding of new vendors to support provider network operations, ensuring compliance with CMS, state, and federal regulations.
- Conduct PACE orientation and regulatory training for contracted providers to ensure network readiness and alignment with quality and compliance standards.
- Implement vendor oversight processes including onsite monitoring, performance evaluations, and corrective action plans to support network performance improvement.
- Analyzed operational and regulatory data; prepared monthly and quarterly reports to monitor network performance and inform leadership decision-making.
- Collaborate with the Third-Party Administrator (TPA) to resolve claims pend issues, improve adjudication accuracy, and support contracted vendor reimbursement.
- Conducted internal audits to assess adherence to regulatory standards and protocols.
- Reviewed documentation for accuracy and completeness in compliance-related processes.
Practice Manager II - Western Carolina Women’s Specialty Center (PSG)
HCA Healthcare
, NC
08.2022 - 01.2024
- Managed daily operations for specialty practice, facilitating 1,200+ patient encounters monthly, ensuring efficient workflow and patient care.
- Led team of 10-12 staff and 4-5 providers, streamlining workflows and minimizing scheduling delays.
- Maintained patient satisfaction scores above 95%.
- Completed provider recredentialing with zero lapses, ensuring uninterrupted network participation.
- Resolved escalated customer service issues in a timely manner while maintaining a high level of professionalism.
- Managed vendor relationships for supplies and services related to the practice.
- Performed administrative tasks such as creating budgets and forecasts, preparing invoices and contracts, ordering supplies and equipment.
- Facilitated implementation of new technology systems into existing workflows in order to improve operational efficiency.
- Assessed medical office operations, identified areas of improvement, and developed plans for corrective action.
Business Operations Coordinator - CarePartners PACE
HCA Healthcare
, NC
03.2021 - 01.2024
- Balanced and verified Medicaid/Medicare payments monthly, ensuring accuracy of participant financial records and compliance with regulations.
- Submitted monthly and quarterly state reports with 100% on-time compliance.
- Collaborated with DSS offices and TPAs to resolve eligibility and payment issues, improving processing accuracy.
- Supported enrollment, billing, and compliance workflows for 300+ participants annually, enhancing service delivery and participant satisfaction.
Education
Master of Health Care Administration -
Louisiana State University
ShreveportBachelor of Science -
Louisiana State University
Baton Rouge, LASkills
- Medicaid/Medicare Compliance
- Claims Processing and Adjudication
- Contract compliance
- Provider Network Management
- Network Performance Analysis
- Compliance Coordination
- Audit support
- Data Tracking & Quality Oversight
- Provider Issue Resolution
- Cross-Functional Collaboration
- Provider Engagement
- Provider relations
Timeline
Health Plan Compliance Analyst - CarePartners PACE
HCA Healthcare
01.2024 - Current
Practice Manager II - Western Carolina Women’s Specialty Center (PSG)
HCA Healthcare
08.2022 - 01.2024
Business Operations Coordinator - CarePartners PACE
HCA Healthcare
03.2021 - 01.2024
Master of Health Care Administration -
Louisiana State University
Bachelor of Science -
Louisiana State University