Marilyn Juarez
Mission Hills
Summary
Experienced compliance professional prepared to lead and enhance compliance programs. Adept at risk assessment, regulatory analysis, and policy implementation. Strong focus on collaboration, achieving results, and adapting to evolving requirements. Known for reliability, integrity, and effective communication.
Overview
12
12
years of professional experience
1
1
Certification
Work History
Clinical Compliance Program Manager
Elevance Health
07.2023 - Current
- Manage and coordinate the development, approval, implementation and compliance of on-going internal & external client facing programs
- Oversight of clinical Policies & Procedures, including creation and on-going monitoring in collaboration with Health Care Management Leadership
- Oversight of clinical program descriptions, including creation and on-going monitoring in collaboration with Health Care Management Leadership
- Oversight of clinical committees, including creation and on-going monitoring in collaboration with Health Care Management Leadership
- Provides subject matter expertise in response to day-to-day external client facing business issues
- Research applicable subject matter practices and remains aware of industry trends
- Manage external client facing relationships and partners with corporate and regional business areas
- Coordinates training related to external client facing program
- Develop program success measures and performs periodic assessments of program success
- Remote Work From Home
Project Leader
Elevance Health
11.2022 - 07.2023
- Supporting all regional management in overall objectives
- Structure, implement and maintain process improvement
- Prepare and deliver presentations as required
- Responsible for supporting projects and the project staff in a dedicated project management business unit
- Partnered with Cost of Care for initiative implementation
- Build, execute and maintain project plan and schedules
- System implementation for documentation and project status tracking
- Monitor activities to ensure project objectives are met within established time frames and budgets
- Scheduling, conducting
- Assessing costs and savings and assist in the payments of vendor invoices
- Remote Work From Home
Project Administrator
Elevance Health
03.2021 - 11.2022
- Responsible for supporting projects and the project staff in a dedicated project management business unit
- Partnered with Cost of Care for initiative
- Managed from beginning to end
- Supporting with Nurse Bio Marketing project for all CST Teams across CST
- Review templates for accuracy
- Build and maintain project plan and schedule
- Contributes to ensuring project deliverables are met
- Assist in documentation and project status tracking
- Monitor activities to ensure project objectives are met within established time frames and budgets
- Scheduling, conducting, and attending meetings
- Supporting management in overall objectives
- Assessing costs and savings and assist in the payments of vendor invoices
- Prepare and deliver presentations as required
- Remote Work From Home
Grievance & Appeals Analyst
Elevance Health
12.2012 - 03.2021
- Manage mid to high call volume
- Manage and verify member data information
- Initiated and close member appeal maintaining integrity and accuracy utilizing CMS guidelines
- Update member appeal cases with decision letters issued by Quality Improvement Organization (QIO)
- Manage administrative related case follow up inquiries for internal and external representatives with efficiency
- Aid in comprehensive departmental needs training for new staff, on boarding and current staff members upon needs
- Performed case audits and review cases to verify compliance with applicable CMS guidelines
- Actively pursues personal learning and development opportunities, being cross trained with the ALJ and Intake claims process and assist upon request
- ALJ Hearing case preparation: Review case, obtain all documents to build case, present case to the Judge
- Intake Claims Process: Review case and allocate claim to line items, create claims case and submit to claims team for validation
Education
Bachelor of Arts - Business Management W/conc. in Logistics & Operations
Southern New Hampshire University
Hooksett, NH01.2024
Associate of Arts - General Studies W/conc. in Business Management
Southern New Hampshire University
Hooksett, NH01.2016
Skills
- State Regulatory Compliance
- NCQA Accreditation
- Policy Review Updates
- Process Improvement
- Strategic Planning
- Time Management
- Project & Management Coordination
- Project Management
- Cross Functional Collaboration
- Executive Reporting
- Stakeholder Engagement
- Meeting Facilitation
- Calendar Management
- Communication
- Problem-Solving
- Strong Critical Thinking
- Organizational Skills
- HIPAA
- HIP
- SharePoint
- SNOW
- Microsoft Office: Word, Excel, Access, Outlook, PowerPoint, Adobe Acrobat (PDF), Teams
Certification
- Agile Organizations: Agile Models & Scaling Agile: Skillsoft through Elevance Health Learning Portal,07/21/2022 - Woodland Hills, CA
- Certified Associate Project Management Development Program (CAPM): Skillsoft through Elevance Health Learning Portal – Project Management Concepts,07/2022 – Woodland Hills, CA
- Certification: Medical Assistant,03/1995 Concorde Career College - North Hollywood, CA
Languages
Spanish
Full Professional
Timeline
Clinical Compliance Program Manager
Elevance Health
07.2023 - Current
Project Leader
Elevance Health
11.2022 - 07.2023
Project Administrator
Elevance Health
03.2021 - 11.2022
Grievance & Appeals Analyst
Elevance Health
12.2012 - 03.2021
Associate of Arts - General Studies W/conc. in Business Management
Southern New Hampshire University
Bachelor of Arts - Business Management W/conc. in Logistics & Operations
Southern New Hampshire University
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