ELIZABETH ANN RUIZ-STRICKLAND
Phoenix,Arizona
Summary
Results-oriented law enforcement and investigation specialist with extensive experience coordinating investigations, researching case files, and conducting interviews. A resourceful leader who maintains an alert and open perspective during investigations, employing expert problem-solving skills to solve complex cases. Successful investigator with a strong background in casework seeking a position within a reputable organization.
Overview
32
32
years of professional experience
1
1
Certification
Work History
Contract Identity Theft Investigator
Arizona Department of Economic Security
Phoenix, USA
01.2021 - 09.2022
- Company Overview: Office of Inspector General (OIG)
- Reviewed and researched allegations of ID theft and fraud abuse dynamics related to the Unemployment Insurance (UI) and Pandemic Unemployment Assistance (PUA) programs by claimants, the general public, and law enforcement
- Facilitated confidential investigative phone interviews
- Provided creative, complex case investigation and resolution
- Identified discrepancies and problems
- Collected and preserved evidence and information, always maintaining the highest level of confidentiality and integrity
- Complied with federal and state law, regulations, policy, and programmatic materials and systems
- Built strong relationships with governmental and law enforcement agencies to reduce process complexity and investigative roadblocks
- Resolved issues and initiated escalations with impartiality
- Office of Inspector General (OIG)
Document Control Specialist
Insurance Tracking Services
Phoenix, USA
04.2018 - 03.2019
- Operated computer, keyboard, and scanner to compile, type, revise, combine, edit & store documents/files
- Compiled documents for scanning
- Proofread filenames and titles and entered details into the computer system
- Determined format & content required in compliance with company policy
- Entered alphabetic, numeric, and symbolic data using a keyboard to create labels for each file
- Entered commands and established spacing, margins, type size, style, color, and other parameters using computer & word processing software and with accuracy
- Stored completed files in shared computer storage
- Made repairs to the scanning machine as needed
- Completed temporary work assignments within 12 months, demonstrating my ability to adapt and deliver results in a fast-paced environment
Appeals Analyst
United Healthcare Evercare Select
Phoenix, USA
10.2011 - 11.2014
- Performed investigative research aligned with the Arizona Health Cost Containment System (A.H.C.C.C.S.), federal (C.F.R.s), and state laws, regulations, relevant regulatory standards, and contracts
- Analyzed medical evidence, documentation, contracts, and disputes
- Demonstrated financial management and contract enforcement
- Rendered impartial, legally sound, and accurate written decisions based on evidence and facts pursuant to Federal & State regulations and statutes
- Gathered and administered key appeals and evidentiary documentation
- Built strong relationships with governmental departments, departments within UHC-ES, and internal and external attorneys to mitigate duplication of efforts, streamline processes, obtain necessary evidence, and ensure compliance and proper reimbursement
- Negotiated payments, thereby mitigating court costs, streamlining processes, and ensuring compliance
- Read and complied with contractual agreements and corporate compliance
- Presented unbiased, factual testimony and documentary evidence, citing applicable laws, regulations, and contractual obligations to the Administrative Law Judge and parties involved
- Prepared files and exhibits for hearings
- Represented UHC-EC at all State Fair Hearings
- Administered dispute files via M.S
- Access, generating daily, monthly, and quarterly reports
- Performed data analytics, statistical modeling, and reports using Excel
- Trusted departmental liaison and problem solver
- Successfully developed recommendations that improved program operations and corrected operational deficiencies
Hearing Officer II
State of Arizona
, USA
02.1991 - 11.2011
- Company Overview: Arizona Health Care Cost Containment System (AHCCCS)
- Reviewed previously adjudicated hospital, provider, and AHCCCS (Medicaid) member disputes, grievances, and/or appeals to determine jurisdiction, legal issues, and amount of program liability according to law, regulations, and policy to determine a conclusion
- Independently conducted legal research on complex regulatory issues, ensuring compliance, and investigated all allegations raised by providers and members
- Analyzed and interpreted federal (CMS-Medicaid) and state laws, rules and policies, contracts, intergovernmental agreements, State Plan, programmatic materials & systems, collected and prepared documentary evidence for administrative hearings
- Prepared and issued written, impartial, legally sound, and accurate written decisions and appeal rights based on research
- Provided solutions to providers in anticipation of future needs
- Analyzed/Audit hospital and provider medical claims for compliance and accuracy, including HCPCS, ICD-9, and CPT Codes
- Resolve complex legal and claim issues
- Analyzed and reviewed medical evidence
- Interviewed, questioned, and/or corresponded with claimants and/or agents to elicit additional information
- Analyzed/audited health plans and provider medical claims for compliance and accuracy
- Analyzed encounters and recommended adjudication of payment
- Authorized and ordered adjudication of valid claims
- Counseled providers and recommended acceptance of negotiated settlement offers, thereby mitigating court costs, streamlining processes, and ensuring compliance
- Provided oral communication and/or written assistance to internal/external parties
- Educated providers in acceptable claim submission requirements (paper and electronic), coding issues, and provider resources (i.e., provider manuals, websites, [AHCCCS (Medicaid), ADHS, Health plans, etc.])
- Successfully developed recommendations that improved program operations and corrected operational deficiencies
- Represented AHCCCS (Medicaid) at State Fair Hearings (Office of Administrative Hearings/OAH)
- Built strong relationships with internal and external attorneys
- Arizona Health Care Cost Containment System (AHCCCS)
Education
University of Phoenix
Phx, AZ01.1994
Skills
- Analytical
- Detail-oriented
- Persuasiveness
- Observant
- Ethical Decision-Making
- Exercises Discretion
- Structured Problem Solving
- Technology Skills
- Investigative Research
- Regulatory Research
- Analytical Problem-Solving
- Interviewing
- Clear Documentation Practices
- Analysis
- Customer Service
- Proficient in Interpersonal Communication
- Critical Thinking
- Caseload Management
- Collaboration
- Effective Team Collaboration
- Deductive Reasoning
- Good Time Manager
Certification
- Association of Fraud Examiners (ACFE), 673879
- AZ State Department Of Public Safety, Level One Fingerprint Clearance Card, 2021P02976
Computerprograms
- TRACERS
- Fortis Imaging
- ETS
- C.L.E.A.R. (Read records only)
- COSMOS
- Google Products
- PUA, GUIDE/PMMIS, and EGRC
- Care One
- Android & iPhone User
- Pro-Law
- EDSS
- Internet Explorer
- Microsoft Word/Excel/Docs/Outlook
- ACCESS
- IDRS
- Unity Messaging
Timeline
Contract Identity Theft Investigator
Arizona Department of Economic Security
01.2021 - 09.2022
Document Control Specialist
Insurance Tracking Services
04.2018 - 03.2019
Appeals Analyst
United Healthcare Evercare Select
10.2011 - 11.2014
Hearing Officer II
State of Arizona
02.1991 - 11.2011
University of Phoenix
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