Janine Archie
Oklahoma City,OK
Summary
Mission focused highly skilled professional with broad compliance and program management experience. Knowledgeable professional with 7 years in compliance-related positions. Strong verbal and written communication skills with a systematic and diligent approach. Forward-thinking team leader skilled at operating departments efficiently to meet goals. Successful background matching employees with roles for maximum performance. Proactive and hardworking individual focused on continuous operational improvement.
Overview
11
11
years of professional experience
Work History
Compliance Manager
Oklahoma Health Care Authority 4345 Lincoln Blvd
05.2021 - Current
- Hours per week: 40
- Duties, Accomplishments and Related Skills:
- Developed and delivered training programs to inform new and current employees about compliance issues.
- Responsible for identifying with attention to detail on reported areas or findings that could majorly impact Medicaid program
- Manage projects representing unit in communicating team's status, activities, and outcomes to OHCA departments, contractors, legislatures, and stakeholders
- Assess readiness reviews and provider tier agreements while assisting in writing member and provider letters
- Create change orders that affect audit processes, provider measures, and member medical Agreements
- Track performance metrics around system processes and reports while working with department managers to adjust and implement strategies to improve performance under overall goals of Oklahoma Medicaid program
- Responsible for project managing for unwinding of public health emergency while interacting with OHCA C-Suite, agency partners, Oklahoma legislatures, CMS, and state of Oklahoma Department of Health & Human Services
- Meet with state and federal officials to develop and approve strategies and implement policies for Medicaid options
- Prepared and wrote over 1500 compliance reports
- Create and write SOP for divisions and units
- Create and write white paper document and present those findings to C-Suite, legislatures, and stakeholders
- Reviewed documents, files, transcripts and other records to assess compliance and potential risk.
- Managed compliance efforts, reporting and audits.
- Consulted with clients on best practices and served as project manager for all process improvements and regulatory initiatives
- Managed full life cycle of assigned audits in alignment with departmental procedures, delivering progress as well as closing reports to senior management and clients
- Liaised with leadership to identify and target inefficiencies in areas of risks and business controls, process gaps and workflow discrepancies
Member Services Manager II
Oklahoma Health Care Authority 4345 N Lincoln Blvd
10.2018 - 05.2021
- Hours per week: 40 Hours per week
- Duties, Accomplishments and Related Skills:
- Assisted call center agents in responding to over 190,000 member inquiries each year, along with automated real-time eligibility system used by over 900,000 applicants yearly while assisting coordinators with making concise and critical determinations
- Interviewed potential Medicaid members by running SAVE reports to confirm validity of passports; naturalization; certificate of citizenship; I-20; I-94, I-551; I-766, and refugee statuses (207; 203, and others) from (USCIS) federal agency, and (DHS) to ensure validity for Oklahoma Medicaid residence policy
- Checked eligibility by validating income through IRS; Oklahoma Security Commission; Social Security Administration through Bendex system; or employer directly
- Assisted members in claims dealing with Medicare and Medicaid policies and procedural, HCPCS, ICD-9, and ICD-10 codes
- Researched and identified Medicaid fraud, tracked, trended and monitored all call volumes, from staff and contractors to ensure policy accuracy
- Worked with IT unit to develop and create new functions for Oklahoma Medicaid online application
- Trained and guided over 200 team members to maintain high productivity and performance metrics
- Followed established auditing processes to meet internal and regulatory requirements.
- Analyzed data and findings to prepare reports detailing financial information.
- Planned audits and audit activities to allocate necessary resources and determine consistency of plans with audit objectives.
- Handled problematic customers and clients to assist lower-level employees and maintain excellent customer service
- Scheduled employees for shifts, taking into account customer traffic and employee strengths
- Tracked employee attendance and punctuality, addressing repeat problems quickly to prevent long-term habits
- Recruited, hired, and trained initial personnel, working to establish key internal functions and outline scope of positions for new organization.
- Observed each employee's individual strengths and initiated mentoring program to improve areas of weakness.
- Implemented innovative programs to increase employee loyalty and reduce turnover
- Launched staff engagement, gender diversity and cultural programs in addition to robust reporting tool that increased operational quality
- Filed court documents and legal pleadings with court clerk on behalf of attorneys.
- Worked alongside attorneys, administrative assistants, and fellow legal assistants on complex cases and legal processes.
- Maintained court dockets and updated disposition of cases after court hearings and trials.
Member Services Coordinator III
Oklahoma Health Care Authority 4345 N Lincoln Blvd
09.2012 - 10.2018
- Hours per week: 40 Hours per week
- Duties, Accomplishments and Related Skills:
- Served as team lead in planning, developing, training and coordinating activities necessary to operate member services daily on behalf or in absence of managers
- Provided comprehensive program training to staff, contractors, agency partners, stakeholders, and CMS regarding Medicaid policies while interpreting policy questions accurately
- Answered complex incoming telephone and written inquiries accurately and timely from members, providers, state legislatures, CMS, vendors, county offices, and state offices
- Assisted members in claims dealing with Medicare and Medicaid policies and procedural, HCPCS, ICD-9, and ICD-10 codes
- Researched and interpreted federal rules and procedures concerning Medicaid.
- Confidently worked with multiple PC screens while utilizing systems such as DHS, MMIS, ATLANTES, and other agency systems, along with those requiring document imaging software
- Representative for agency partner seminars, training forums, and conferences with state legislatures
- Assisted Managers with special projects and created specialized training materials for department and other units
- Resolved complex complaints from members, providers, OHCA staff, and State legislatures
- Identified potential operational and contractual issues
- Independently communicated and resolved problems with providers and members regarding Medicaid program through reports, written correspondence, telephone calls, and face-to-face interviews.
- Facilitated tracking call center phone queues, monitoring staff, reporting staffing issues, and reporting monthly statistics to managers while indirectly managing team.
- Delivered exceptional customer service to every member by leveraging extensive knowledge of products and services and creating welcoming, positive experiences
- Exhibited high energy and professionalism when dealing with clients and staff
- Responded proactively and positively to rapid change
- Promoted superior experience by addressing customer concerns, demonstrating empathy, and resolving problems swiftly
- Followed up with customers about resolved issues to maintain high standards of customer service
- Educated customers about billing, payment processing and support policies and procedures
- Collaborated with staff members to enhance customer service experience and exceed team goals through effective client satisfaction rates
- Performed observations and evaluated supporting documents to supplement audit findings.
- Followed established auditing processes to meet internal and regulatory requirements.
Education
Bachelor's Degree Education - undefined
University Of Central Oklahoma
Edmond, OK12.2018
Skills
- COMPUTER INFORMATION TECHNOLOGY SKILLS
- Proficient in use of most major computer systems, information systems, spreadsheet applications, graphic and presentation applications, word processing applications
- RELEVANT PROFESSIONAL DEVELOPMENT AND QUALIFICATIONS
- Highly skilled professional with broad compliance, manager and program management experience
- Compliance documentation
- Conducting investigations
References
- REFERENCES AVAILABLE UPON REQUEST
Timeline
Compliance Manager
Oklahoma Health Care Authority 4345 Lincoln Blvd
05.2021 - Current
Member Services Manager II
Oklahoma Health Care Authority 4345 N Lincoln Blvd
10.2018 - 05.2021
Member Services Coordinator III
Oklahoma Health Care Authority 4345 N Lincoln Blvd
09.2012 - 10.2018
Bachelor's Degree Education - undefined
University Of Central Oklahoma
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