Kimberly Jean Baptiste
Queens Village,NY
Summary
Accomplished and detail-oriented Regulatory Affairs and Compliance Professional with over 20 years of experience in the healthcare and insurance industry. Demonstrates expertise in regulatory oversight, audits, utilization management, and vendor compliance, particularly within Medicare and Medicaid environments. Proven ability to identify organizational risks, improve processes, and ensure full compliance with CMS and state regulations. Recognized for excellent interpersonal, analytical, and organizational skills with a history of cross-functional collaboration and stakeholder satisfaction.
Overview
18
18
years of professional experience
Work History
Regulatory Specialist, Clinical Vendor Management and Oversight
HealthFirst
03.2020 - Current
- Monitors compliance with CMS and NYS DOH regulations for all delegated vendors.
- Reviews audit reports and assists in developing and tracking CAPs to resolution.
- Collaborates with internal regulatory and business teams to align deliverables.
- Identifies risks and implements process improvement initiatives.
- Ensures timely vendor documentation and reporting compliance.
Regulatory Affairs Analyst
UnitedHealthcare
07.2013 - 03.2020
- Investigated and prepared over 500 Fair Hearing cases annually for ALJ review.
- Interpreted new healthcare laws and ensured regulatory alignment.
- Tracked and documented compliance with Decision and Order directives.
- Supported audits and facilitated stakeholder communications.
- Contributed to the creation of SOPs, job aids, and training materials.
Insurance Specialist
Group Health Incorporated (GHI)
08.2007 - 07.2013
- Served as liaison with state agencies, ensuring regulatory coordination.
- Investigated over 400 complex claims and documented detailed case files.
- Managed intake of over 2,000 cases, improving processing efficiency by 30%.
- Conducted internal audits and supported Grievance and Appeals reviews.
- Developed cross-departmental communication strategies for case resolution.
Education
Bachelor of Science - Data Analytics and Project Management
Southern New Hampshire University
01.2025
Business Communication Coursework
Baruch College, CUNY
01.1999
Skills
Regulatory Affairs & Government Programs Compliance
Languages
English: Native proficiency
Haitian Creole: Full professional proficiency (ILR scale)
Timeline
Regulatory Specialist, Clinical Vendor Management and Oversight
HealthFirst
03.2020 - Current
Regulatory Affairs Analyst
UnitedHealthcare
07.2013 - 03.2020
Insurance Specialist
Group Health Incorporated (GHI)
08.2007 - 07.2013
Bachelor of Science - Data Analytics and Project Management
Southern New Hampshire University
Business Communication Coursework
Baruch College, CUNY