Summary
Overview
Work History
Education
Skills
Timeline
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Colleen Shupe

Tampa

Summary

Experienced professional in the Health Care space. Demonstrated history of working cross-functionally to ensure high quality standards and compliance metrics are consistently met. Prioritizes projects and multitasks effectively to achieve project goals. Methodical and detail-oriented team player with expertise in team leadership.

Overview

8
8
years of professional experience

Work History

Medicaid Quality Program Administrator

Liberty Dental Plan
08.2021 - Current
  • Monitor contractual key performance indicators (KPIs) and establish specific and measurable outcomes aligned with organization's overall mission.
  • Collaborate with various teams to uncover issues, identify applicable solutions, and offer guidance.
  • Establish program policies and procedures to comply with regulatory requirements.
  • Analyze Member and Provider satisfaction data and implement corrective action plans based on survey results.
  • Communicate with State regulators.
  • Develop and implement marketing strategies to promote program awareness and participation.
  • Provide ongoing direction and leadership for program operations.
  • Create and present quarterly Key Performance Indicator (KPI) reports for executive staff.

Medicare Regulatory Specialist

WellCare Health Plans
05.2019 - 08.2021
  • Intakes memorandums directly from the Centers for Medicaid and Medicare Services (CMS).
  • Summarized and distributed informational and actionable CMS memorandums to applicable business areas.
  • Provide regulatory guidance and CMS manual/chapter interpretation to business areas.
  • Served as regulatory compliance subject matter expert for the following business areas: pharmacy/formulary, product/plan benefits, grievance and appeals, government system access.
  • CMS audit support.
  • Prepared and submitted regulatory file applications to CMS.

Operations Support Specialist

WellCare Health Plans
07.2017 - 05.2019
  • Provided complete support for Call Center operations including but not limited to: call tools, process step actions, corporate policies, system scripting and process flows/work-arounds, hosts bi-weekly support meeting with Call Center leadership.
  • Travels to Call Centers to provide side-by-side agent training, provide support for site leaders, identify gaps in process/call center needs.
  • Prioritize various initiatives and align with market leaders.
  • Support Call Center operations during audits.

Regulatory Research Coordinator

WellCare Health Plans
09.2015 - 06.2017
  • Facilitated the Medicaid Fair Hearing process for WellCare's Staywell Health Plan
  • Organized and presented medical records, authorization, grievance, and appeal data
  • Corresponded directly with the Agency for Health Care Administration and the Department of Children and Families regarding Fair Hearing cases
  • Knowledge of State contracts and policies.
  • Corresponded with internal departments as well as members regarding the Fair Hearing process, including but not limited to: scheduling, evidence packets, new evidence/documents, medical records, hearing outcomes.

Education

Bachelor of Science - Sociology

Florida State University
Tallahassee
12.2013

Skills

  • Training
  • Operational Efficiency
  • Policy and Procedure development
  • Contract interpretation and implementation
  • Regulatory Compliance
  • Customer Service
  • Performance Standards and Analysis
  • Board of Directors Support
  • Microsoft Office

Timeline

Medicaid Quality Program Administrator

Liberty Dental Plan
08.2021 - Current

Medicare Regulatory Specialist

WellCare Health Plans
05.2019 - 08.2021

Operations Support Specialist

WellCare Health Plans
07.2017 - 05.2019

Regulatory Research Coordinator

WellCare Health Plans
09.2015 - 06.2017

Bachelor of Science - Sociology

Florida State University

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Colleen Shupe