Jamillah Reynolds
Toledo,OH
Summary
I am a detail-oriented Healthcare Executive Compliance Officer currently working in an interim research role as a Provider Operations Manager, with over 15 years of experience in risk management, internal audits, MTM/LDLA Audits, iCaps, policy and procedure development. I have also served as the sole assessor for Provider Data Solutions enterprise Medicare/Medicaid Compliance C360 risk assessment alerts and have expertise in strategic planning.
I possess advanced knowledge of regulatory integration compliance and process mining and have a proven track record of partnering with executives and business leaders to identify vulnerabilities and create corrective actions. My collaborative and team-oriented approach, coupled with excellent communication and interpersonal skills, has helped me foster strategic partnerships and promote the company's reputation.
Overview
10
10
years of professional experience
1
1
Certificate
Work History
Regulatory Compliance Provider Operations Manager
Elevance Health Formerly Anthem Inc.
05.2017 - Current
- Actively participates in efforts to understand Quality issues and drivers and Learning needs to improve overall Provider Data Solutions performance.
- Acts as executive liaison to resolve problems and ensure successful implementation of company initiatives.
- Builds culture of continuous improvement across Provider Data Solutions business areas, continuing to assess compliance driven quality improvement opportunities and identify learning needs as business needs, processes, and technologies change for impacted Provider Data Solutions business areas.
- Champions Provider Data Solutions learning organization's capabilities with functional leadership to strengthen understanding of learning strategies and offerings.
- Cultivates trusted relationships with critical business partners, such as Enterprise Learning, Development, Quality, Privacy, Compliance / Regulatory Integration (RI), Market Health Plans, HCN, Provider Networks, Provider Solutions, Legal, and IT, and supports areas in identifying improvements and opportunities for streamlined collaboration.
- Develops executive presentations, reports and communications while ensuring broad consistency and efficiency.
- Ensure line of business goals are translated to network activities and tactics needed to support goals.
- Ensures understanding of business educational needs, capability gaps, and opportunities by fostering internal trust and building relationships with leaders within Provider Data Solutions at all levels.
- Hires, trains, coaches, counsels, and evaluates the performance of direct reports; involved with hiring, training, coaching, and evaluation of indirect reports and team members in both Quality and L&D.
- Leads comprehensive strategic and annual planning while working with executive leaders to integrate business planning with financial planning and coordinate efforts with other parts of Elevance Health.
- Leads all market documentation planning support activities for Provider Data Solutions; facilitates market plans for all markets at state level across each line of business.
- Led a team of strategic consultants working on unique value-based special projects to drive the future vision across broader Elevance Health enterprise.
- Organizes problem-solves, raises issues, and integrates initiatives, solutions, and actions.
- Oversees development and analysis of reporting and analytics to drive Quality Learning & Development insights and inform opportunities.
- Responsible for completing high level activities directly on behalf of PDS and market health plan executives, related to key programs or strategic initiatives.
- Understands Compliance Regulatory Integration (RI) Quality outcomes and related process changes, facilitates annual and off-cycle policy and procedure reviews, and works with teams to proactively update and improve learning development, and documentation governance oversight strategy.
Strategic Sourcing Manager
Anthem Inc.
04.2015 - 05.2017
- Built and maintained strong working relationships with internal customers and key suppliers for sourcing categories and various projects.
- Executed standardized strategic sourcing processes for assigned projects.
- Executed strong contract negotiations and legal understanding of terms and conditions.
- Reduced operating cost related to office supplies by 50%.
- Facilitated cross-functional teams to aggressively track and improve supplier performance.
- Served as project manager for several key initiatives in supply chain business areas while facilitating large, complex supplier contract projects.
Customer Services Manager
CareMore / Wellpoint Inc.
08.2013 - 03.2015
- Assumed ownership over team productivity and managed work flow to meet or exceed quality service goals.
- Collaborated with upper management to improve customer service processes and support structures company-wide.
- Researched and observed emerging markets and market shifts to take advantage of potential leads and new markets.
- Resolved customer complaints while prioritizing customer satisfaction and loyalty.
- Reviewed repeated issues within operations and business management to solve problems and improve company outcomes.
- Supervised employees and assessed performances to determine training needs and define accurate plans for decreasing process lags.
- Took ownership of customer issues and followed problems through to resolution.
- Trained and regularly mentored associates on performance-oriented strategies and customer service techniques.
Education
MBA - Executive MBA / J.D.
University of Toledo
Toledo, OH05.2017
Bachelor of Science - Management Science Information System
Tuskegee University
Tuskegee, AL05.2003
Skills
- Learning Champion for Elevance Health Centers of Excellence
- Wealth of expertise in, strategic planning, governance, contracting, analytics, and negotiation
- Oversight of market-specific appendices for all markets and LOBs has resulted in successful partnerships with internal partners
- Experience in scaling organizations for growth and negotiating risk contracts with Medicare, Medicaid, and commercial provider groups
- Develops strong relationships both internally and externally, contributing to success of Elevance Health's compliance with regulatory integration, DMHC/CDI filings, and NCQA accreditation standards skillfully navigating complex market nuances utilizing process mining
- Effectively navigate complexities of healthcare
Accomplishments
- Oversight of Enterprise Compliance Risk Assessments for all PDS business areas. Assessing over 10,000+ Compliance C360 alerts per year mitigating impacts to PDS business areas for all markets and LOBs.
- Oversight of CMS - PDSO object store and PDSO Knowledge Library repository managing over 1000+ documents (DLPs, MSA, QRGs etc.) for all markets and LOBs.
- Mitigated internal / external audit findings surrounding Demographic Data Operations.
- Responsible for external DMHC filing on behalf of PDS.
- Selected as a Learning Champion by the Automation & Process Academy to lead a new process mining driven team.
- Elevance Health Impact Award recipient.
- Mitigation actions - created an application PDS Compliance RI Collaborative Workspace, this app allows for streamlined collaboration, strategy and governance.
Affiliations
Alpha Kappa Alpha Sorority, Inc.
Certification
Lean Six Sigma
- Yellow Belt - August 2023
Timeline
Regulatory Compliance Provider Operations Manager
Elevance Health Formerly Anthem Inc.
05.2017 - Current
Strategic Sourcing Manager
Anthem Inc.
04.2015 - 05.2017
Customer Services Manager
CareMore / Wellpoint Inc.
08.2013 - 03.2015
MBA - Executive MBA / J.D.
University of Toledo
Bachelor of Science - Management Science Information System
Tuskegee University
References
Michelle Webb - PDS Director of Business Improvement - previous supervisor - michelle.webb@elevancehealth.com
Phil Weber - PDS Manager II - current supervisor - phil.weber@elevancehealth.com
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