CABRINA "KERRIE" TROVINGER
Greater Denver/Littleton
Summary
Over 25 years professional experience in the insurance and regulatory industry as a Medicare Consultant, Regional Quality Analyst, Examiner in Charge, and Examiner. Extensive experience in policy form review, market conduct examinations, litigation management, consumer complaints, health insurance products, and liability/automobile/property and casualty claims handling. Deep experience with professional auditing standards, knowledge of health care laws and insurance regulations, lean process, quality assurance, presentation, training, medical claims, coding, billing, and regulatory compliance.
Overview
25
25
years of professional experience
Work History
Examiner-in-Charge
EXAMINATION RESOURCES
03.2021 - Current
- Health Insurance Examiner and Examiner-in-Charge for Health Policy Form Examinations and Market Conduct Investigations for 22 states representing Centers for Consumer Information and Insurance Oversight (CCIIO)
- Form reviews of Health products for Qualified and Non-Qualified Health Plans within Individual, Small Group, Large Group markets, Transitional, Student Health Plans, Non-Federal Governmental and Minimum Essential Coverage plans
- Market Conduct work in Preventative Services, Consolidated Appropriations Act, and Affordable Care Act related examinations
- Extensive knowledge of Local, State, and Federal laws and regulations pertaining to the Affordable Care Act and the Consolidated Appropriations Act
- Familiarity with MHPAEA, NMHPA, EHB, HIPPA, and ERISA as well as the use of CMS DCT and CAT RX review tools, HIOS, TeamMate+, and SERFF.
Property Design Manager
VORTCO HOLDINGS
01.2018 - Current
- Researched single family residential property and market conditions to determine favorability for investment
- Negotiated with contractors and vendors for supplies and services
- Acquired and renovated eight residential properties
- Managed and maintained rental property.
Audit Specialist
BEHAVIOR ANALYST CERTIFICATION BOARD
01.2019 - 01.2021
- Executed compliance and performance audits for international governing organization responsible for certifying and regulating practitioners within the Profession of Applied Behavior Analysis
- Facilitated process improvement and best practices for a new start-up expansion
- Managed multiple audits simultaneously while completing special projects as assigned.
Medicare Project Consultant
AMERICAN FAMILY INSURANCE
01.2016 - 01.2018
- Lead analyst for a new team analyzing Medicare payments, regulatory compliance and recovery
- Interpreted CMS guidelines
- Created a tracking system for Medicare negotiations and payments rolled out for national implementation
- Engaged consistently with government agencies, clients and providers
- Analysis of billing, coding, medical treatment, payment integrity, and recovery.
Regional Quality Analyst
AMERICAN FAMILY INSURANCE
01.2013 - 05.2015
- Formulated audit charters, reviewed strategy, conducted file review
- Analysis of regulatory compliance, medical billing, coding, Medicare and Liability Claims
- Authored reports and proposals, presented results
- Facilitated action plans, formulation of key metrics, work process and improvement
- Built and delivered training to all levels of the organization.
Senior Claim Examiner
AMERICAN FAMILY INSURANCE
01.1999 - 01.2013
- Extensive experience handling complex medical and casualty claims with analysis of billing, coding, payment, recovery, liability and litigation
- Relied on as a Subject Matter Expert
- Investigated, evaluated and negotiated casualty, property, auto, homeowners and commercial claims
- Identified and prevented fraud, waste, and abuse
- Answered customer complaint calls providing solutions to concerns
- Interacted with state regulatory agencies on case by case basis as needed.
Education
BA - Communications Multi-Major
Metropolitan State College of Denver
Skills
- Audit and Compliance
- Affordable Care Act/No Surprises Act
- CIE/AIE/MCM/HCP/AIC
- Experience with MHPAEA, RX, NMHPA, and EHB Reviews
- Medical and Liability Claims Handling
- Motivated Self-Starter
- Project Management
- Detail Oriented/Highly Organized
- Communications - Verbal/Written
- Dispute Management
Timeline
Examiner-in-Charge
EXAMINATION RESOURCES
03.2021 - Current
Audit Specialist
BEHAVIOR ANALYST CERTIFICATION BOARD
01.2019 - 01.2021
Property Design Manager
VORTCO HOLDINGS
01.2018 - Current
Medicare Project Consultant
AMERICAN FAMILY INSURANCE
01.2016 - 01.2018
Regional Quality Analyst
AMERICAN FAMILY INSURANCE
01.2013 - 05.2015
Senior Claim Examiner
AMERICAN FAMILY INSURANCE
01.1999 - 01.2013
BA - Communications Multi-Major
Metropolitan State College of Denver
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