Tina Sutton-mack
Freeport,NY
Summary
Motivated Team Lead possessing excellent leadership and planning abilities. Dedicated Team Leader with expertise in quality assurance initiatives, issue resolution and interpersonal communication. Sets example for work ethic, punctuality and quality.
Overview
22
22
years of professional experience
Work History
Regulatory Affairs Team Lead of Complaint Analyst
Healthfirst
New York, New York
10.2013 - 10.2023
- Responsible for supervising a team of 8 Complaint Analysts who handle all State complaints received daily
- Review and approve communications to Regulatory agencies
- Including DFS complaints, Fair Hearing compliance letters to DOH OAG letters, CMS responses and other communications as needed
- Serving as the primary point of contact for State and local Regulatory agencies pertaining to member complaints (NYS Department of Health, State Department of Insurance, Center for Medicaid Services and the NYS Office of Attorney General)
- Evaluate trend analysis and collaborate with internal stakeholders to decrease the number of complaints received by NY State and local government Regulatory agencies
- Assisting internal stakeholders with the development of new processes to achieve company-wide solutions, to maintain the company’s 4-star NYS Medicaid and 3.5-star Medicare ratings
- Oversees the submission of reports to government Regulatory agencies to ensure that deadlines are met timely
- Developed quality criteria and metrics for the Complaints Analyst.
Senior QI auditor
02.2004 - 10.2013
- Lead Auditor in 13 successful annual NYS Department of Health CHP Audits and first annual NYS FE Integrity Audit
- Performed internal quality assurance audits of operational processes for internal employees and outsourced vendors to ensure compliance with policies, procedures and quality standards
- Conducted compliance audits to ensure members’ accounts are accurately handled with the plan level selected
- This includes the appropriate handling of effectuations, member record updates, terminations, binder and ongoing premium payments being posted timely and accurately
- Oversee and participate in department compliance, quality improvement and training initiatives regarding new regulations
- Provided recommendations on improving controls to gain efficiency and strengthening of compliance measures
- Presented results of investigations to senior staff and prepare written reports concerning Special Investigation Unit activities
- Used data analysis to make recommendations to improve processes
- Identified defects and improve departmental performance by supporting quality, operational efficiency and production goals
- Assisted in the development of departmental policies and procedures; review the efficiency of existing training
- Established time frames and rates of performance for the quality and quantity of work for the position
- Led development projects for new audits and provide maintenance on established audit processes
- Recorded and tracked quality assessment scores and provide feedback to reduce errors and improve processes and performance to ensure the quality of the network
- Conducted focused audits to prepare for regulatory site visits
- Prepared accurate detail and timely monthly quality reports for all data entry and Quality Assurance staff
- Ensured quality standards for Medicaid, FHP, CHP and Medicare data entry staff are maintained every month
- Enrollment liaison between Sales, Regulatory and Product Management departments.
Enrollment Representative
04.2002 - 02.2004
File Clerk
10.2001 - 04.2002
Education
Some College (No Degree) -
Long Island University
Brooklyn, NYSkills
- Team oriented
- Excellent communication
- Complaint resolution
- Performance Improvement
- Quality Control
- Quality Improvement
- Documentation And Reporting
- Team Supervision
- Leading Team Meetings
- Microsoft Office Suite
- Windows XP
- Market Prominence
- Regulatory Compliance
- Performance monitoring
- Production Monitoring
- Trend tracking
Timeline
Regulatory Affairs Team Lead of Complaint Analyst
Healthfirst
10.2013 - 10.2023
Senior QI auditor
02.2004 - 10.2013
Enrollment Representative
04.2002 - 02.2004
File Clerk
10.2001 - 04.2002
Some College (No Degree) -
Long Island University
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