Karla Mills

• Capture accurate client details in Salesforce, address initial policy questions, and set clear expectations across medical, security, Mortal Remains Transport, and complex travel‑interruption cases.
• Support global travel operations by coordinating flight cancellations and rebookings, assisting with lost passports, arranging ground transport and hotel accommodations, and facilitating medical transportation for clients who fall ill or experience accidents domestically or internationally.
• Provide evacuation support for trekkers in remote regions, including Argentina and Kathmandu, ensuring timely coordination with medical facilities and local partners.
• Manage case progression by updating or elevating statuses, applying correct protocols, and ensuring internal teams and external partners remain aligned throughout the case lifecycle.
• Draft and distribute timely Case Notifications and SITREPs to keep partners and points of contact informed, including during sensitive repatriation and high‑urgency cases.

• Conducted on-site monitoring of disaster debris removal and disposal operations, ensuring strict adherence to FEMA and contractual guidelines
• Inspected haul trucks, verified debris eligibility, and calculated load volumes to support accurate documentation and reimbursement
• Maintained detailed daily logs and photographic records to facilitate audit readiness and regulatory compliance
• Collaborated with field crews, supervisors, and government representatives to resolve discrepancies and uphold operational integrity
• Demonstrated resilience and precision in high-pressure environments, reinforcing transparency and accountability in disaster recovery efforts
• Reduced instances of non-compliance through meticulous monitoring of internal controls and periodic audits.
• Performed quality reviews to uncover workflow and communication issues.

• Managed the intake, review, and coordination of Complaint Tracking Module (CTMs) complaints for CMS, ensuring timely and accurate resolution in compliance with CMS standards.
• Knowledge of Medicare benefits, enrollments and LIS assistance.
• Provided oversight for documentation processes, ensuring consistency and compliance with regulatory requirements.
• Achieved timely resolution of non-conformance issues by implementing corrective action plans working closely with relevant departments.

• Performed comprehensive Quality Assurance assessments of Medicare member materials, meticulously proofreading, editing, and verifying compliance with CMS Marketing Materials models and Source of Truth documentation
• Coordinated the timely processing of documentation for Medicare programs, meeting strict CMS timeline requirements..

• Reviewed medical records to close HEDIS care gaps, maintaining a 97% accuracy rate while ensuring efficient workflow.
• Conducted "Over-reads" audits to ensure the quality and consistency of abstracted medical records.
• Facilitated medical record retrieval from providers within HEDIS collection deadlines to support healthcare quality audits and reporting accuracy.

• Performed comprehensive Quality Assurance assessments of Medicare member materials, meticulously proofreading, editing, and verifying compliance with CMS Marketing Materials models and Source of Truth documentation
• Ensured timely and accurate documentation and mailing of materials in line with CMS requirements.

• Managed communication with patients diagnosed with COVID-19, providing health education and guidance on quarantine procedures.
• Conducted epidemiologic investigations and ensured accurate documentation in authorized systems.
• Enhanced contact tracing efficiency by conducting thorough case investigations and identifying close contacts.
• Adapted quickly to changing protocols as new information became available about COVID-19 transmission patterns, updating procedures accordingly.

• Revamped the organization's complaint and grievance system, categorizing complaints to improve patient care and reducing response time by 15%.
• Managed audits and compliance assessments for various healthcare grants, ensuring adherence to state and federal regulations.
• Led quality initiatives, including HEDIS Medical Records Requests and Risk Adjustment chart abstraction, maintaining compliance with CMS, HRSA, NCQA, HEDIS, and PCMH standards.
• Collaborated with cross-functional teams to develop and implement targeted solutions for identified quality issues, ensuring continuous improvement.

• Led the monitoring and auditing of Appeals and Grievances and Medical Management, ensuring compliance with CMS Medicare Advantage (Part C) guidelines.
• Developed and implemented internal auditing tools to prevent, detect, and correct problem areas, maintaining readiness for CMS external audits.
• Provided project leadership for compliance-related audits, overseeing departmental policies, workflows, and monitoring efforts.

• Conducted regular reviews of company policies and procedures for alignment with regulatory requirements and industry best practices.
• Stayed current with latest changes to applicable regulatory standards and company procedures.
• Streamlined internal audit processes for improved efficiency and accuracy in detecting potential compliance issues.