Courtney Dawson
Pasadena,USA
Summary
As a dynamic leader, I possess exceptional communication skills and a proven ability to navigate complex regulatory environments. I consistently drive compliance initiatives to successful outcomes, ensuring that the organization remains in line with industry regulations. My high level of motivation and social adeptness allows for a unique blend of ambition and strategic thinking, enabling effective team leadership and organizational integrity maintenance.
Overview
12
12
years of professional experience
1
1
Certification
Work History
Manager of Compliance
Community Health Choice
08.2024 - Current
- Facilitated smooth communication and coordination with HHSC for STAR+Plus project launch.
- Implemented best practices throughout the organization with coordination from legal and operational teams.
- Designed performance measurement dashboard to evaluate compliance activities.
- Focused on enhancing regulatory compliance through standardized documentation.
- Advised on compliance with relevant laws, regulations, and standards.
- Devised plans to address identified compliance issues.
- Triaged and followed to closure on average 10 Immediate Jeopardy Cases a month
- Facilitated regulatory compliance through dissemination and oversight of Medicare HPMS memos.
Program Operations Manager
Texas Children's Health Plan
04.2021 - 08.2024
- Directed a team of 25 professionals under the STAR Kids program including Decision Support Specialists, Project Analysts, Program Coordinators, and Quality Improvement Specialists to maintain strict compliance in Care Coordination operations.
- Developed and introduced metrics that successfully addressed Corrective Action Plans.
- Implemented comprehensive State and Internal Reporting projects that cut report preparation time by 75%.
- Led the HHSC MDCP UR Audit annually with precision, ensuring strict regulatory adherence and attaining a 95% success rate.
- Automated manual processes leading to significant reduction in error rates by over 50%.
- Acted as pivotal Epic Superuser for Reporting, ensured proficiency across Healthy Planet and Cogito modules.
Project Manager
Texas Children's Health Plan
10.2019 - 04.2021
- Successfully managed multiple projects simultaneously by prioritizing tasks according to urgency, resource availability, and alignment with organizational goals.
- Planned, designed, and scheduled phases for large projects.
- Met project deadlines without sacrificing build quality or workplace safety.
- Established effective communication among team members for enhanced collaboration and successful project completion.
- Developed comprehensive project plans with clear timelines, milestones, and budget requirements, ensuring timely delivery of high-quality results.
- Monitored progress against established goals, adjusting schedules and resources as needed to keep projects on track.
Project Analyst
Texas Children's Health Plan
04.2018 - 10.2019
- Conducted in-depth research into regulatory domains to effectively bridge legal standards with pragmatic business objectives, resulting in a 15% improvement in the effectiveness of compliance strategies
- Oversaw MDCP UR Audit and Home Visit Process, ensuring compliance with regulations and maximizing operational efficiency at 95%
- Realigned strategic initiatives resulting in 100% compliance in MDCP interest list
- Developed a remote productivity tool during COVID-19 to effectively oversee 250 clinical staff
- Spearheaded a comprehensive revision of 210 policies and procedures to align with organizational needs, enhancing operational efficiency and compliance
- Led the development of the COMCER Plan, ensuring a robust and efficient framework for disaster response and recovery
- Introduced the NCQA Dashboard, significantly improving data visibility and decision-making in Population Health Management
- Played a pivotal role in the ArcGIS Mission Control team, contributing to the creation of a real-time resource heat map that enhanced support and operational effectiveness for over 450,000 members
- Identified a substantial $15.7 million capitation under-payment within the MDCP Program, facilitating corrective actions and ensuring repayment to align with budgetary guidelines
- Directed teams to prioritize outreach efforts to 25,000 high-risk members during the challenging aftermath of Hurricane Harvey, ensuring critical support and resources were delivered to those in need
Business Application Analyst
Texas Children's Health Plan
10.2016 - 04.2018
- Conducted thorough application testing to ensure functionality, reliability, and user satisfaction.
- Developed user-friendly interfaces that simplified navigation within complex applications for non-technical users.
- Leveraged industry best practices in the design and development of cutting-edge business applications.
- Delivered high-quality documentation detailing application features, functions, and processes for easy reference by internal teams and end-users alike.
- Enhanced business application efficiency by optimizing processes and streamlining workflows.
- Implemented new software solutions for improved data analysis and decision-making capabilities.
- Ensured compliance with industry standards and regulations through diligent monitoring of application security measures.
- Assisted in the selection process of third-party vendors for specialized tools needed in the implementation of business-critical applications.
Complaints Resolution Specialist
Texas Children's Health Plan
02.2016 - 10.2016
- Consistently achieved a remarkable 98% resolution rate for member complaints within 30 days, demonstrating commitment to member satisfaction
- Developed and delivered comprehensive training sessions on member complaint protocols biannually, equipping staff with the skills needed to effectively address member concerns
- Ensured 100% compliance in the timely submission of state reports, adhering strictly to established deadlines and regulatory requirements
Practice Administrator
Select Spine And Sports Medicine
01.2013 - 02.2016
- Successfully managed the credentialing process for two providers, securing active contracts and bolstering the operational integrity of the practice
- Spearheaded the technical conversion from ICD-9 to ICD-10, effectively training staff to ensure a smooth transition and optimal system functionality
- Ensured the practice met all criteria for meaningful use, facilitating enrollment and compliance with industry standards
Education
Master of Legal Studies (M.L.S) - Healthcare Law
University of Oklahoma College of Law
Norman, OK08.2021
Bachelor of Science - Healthcare Management
Granite State College
Concord, NH08.2019
Skills
- Leadership
- Project Management
- CMS Programs
- Research and Data Analysis
- Policy Implementation
- Internal Audits
- Performance Monitoring
- Data Management
- Operations Management
- Strategic Planning
- Business Intelligence Tools
Certification
- Six Sigma Lean Black Belt in Healthcare (LBBH)
- Certified Professional Compliance Officer (CPCO)
- Certified Revenue Cycle Specialist-Institutional
- Certified Ethics Associate-IT
Affiliations
- University of Oklahoma Alumni Association-Member
- Texas HOSA-Member and Judge
- AAPCA-Member
- ACHE-Member
Timeline
Manager of Compliance
Community Health Choice
08.2024 - Current
Program Operations Manager
Texas Children's Health Plan
04.2021 - 08.2024
Project Manager
Texas Children's Health Plan
10.2019 - 04.2021
Project Analyst
Texas Children's Health Plan
04.2018 - 10.2019
Business Application Analyst
Texas Children's Health Plan
10.2016 - 04.2018
Complaints Resolution Specialist
Texas Children's Health Plan
02.2016 - 10.2016
Practice Administrator
Select Spine And Sports Medicine
01.2013 - 02.2016
Master of Legal Studies (M.L.S) - Healthcare Law
University of Oklahoma College of Law
Bachelor of Science - Healthcare Management
Granite State College
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