Petrina Russell
Pinebluff,NC
Summary
Results-driven Manager known for high productivity and efficient task completion. Specialize in strategic planning, team leadership, and operational improvement. Excel in communication, problem-solving, and adaptability, ensuring seamless project execution and team cohesion.
Overview
31
31
years of professional experience
1
1
Certification
Work History
Manager of Medicare & Regulatory Compliance
FirstCarolinaCare Insurance Company
Southern Pines, NC
09.2021 - Current
- Supported VP of Compliance in managing comprehensive compliance duties.
- Managed Notices of Non-Compliance and Corrective Action Plans to uphold CMS, Federal, and State regulations.
- Directed a team of Medicare Compliance Analysts conducting marketing material reviews and adhering to CMS regulations.
- Led annual audits by engaging with multiple risk partners and pharmacy benefit managers.
- Facilitated deployment of corrective action plans following non-compliance audits.
- Created and executed policies and procedures to meet state and Federal requirements.
- Demonstrated expertise in adhering to North Carolina regulations for form filings.
- Proficient at crafting compliant documents for Medicare Advantage and State regulations.
Compliance Auditor
FirstCarolinaCare Insurance Company
Southern Pines, NC
05.2016 - 09.2021
- Participated in collaborative efforts to complete CMS Market Conduct Exam.
- Implemented tailored auditing frameworks to ensure compliance with appeals, broker services and credentialing processes.
- Prepared comprehensive CMS Medicare Advantage regulatory paperwork.
- Implemented structured review systems ensuring compliance with regulatory standards across multiple operational areas.
Operations Analyst
FirstCarolinaCare Insurance Company
Southern Pines, NC
03.2015 - 05.2016
- Analyzed and addressed errors in benefits administration and claims operations.
- Aggregate and revise information related to End Stage Renal Disease clientele.
- Coordinated processing of large-scale claims with third-party audit teams.
- Managed subrogation cases involving self-funded health plans.
Account Manager
FirstCarolinaCare Insurance Company
Southern Pines, NC
12.2006 - 03.2015
- Oversaw customer service and administrative functions for 116 commercial Fully-insured & Self-funded group accounts totaling over $31 million in premiums.
- Qualified to facilitate sales of dental coverage, group health benefits, and Medicare Advantage options.
- Produced detailed guide aiding new employees in understanding account management roles.
- Collaborated with teams to draft and finalize commercial Certificate of Coverage Policies.
Office Manager
Allergy Partners of Pinehurst
Pinehurst, NC
06.1994 - 12.2006
- Executed initial and ongoing credential management for multiple healthcare providers across diverse insurance networks.
- Maintained impeccable office organization to support efficiency, professionalism and performance objectives.
- Managed billing operations and monitored discrepancies for resolution.
- Performed transcription tasks for numerous healthcare professionals.
Education
Associate of Applied Science - Paralegal Studies
Central Carolina Community College
Sanford, NCBachelor of Science - Accounting
Franklin University
Columbus, OHSkills
- Medicare & Regulatory Compliance
- Problem-solving
- Effective Team Leadership
- Proficient Scheduling Skills
- Strategic Decision-Making
- Project Coordination
- Policy Development
- Strong Organizational Abilities
- Detail-Oriented
- Audit Management
- Dependable and responsible
Certification
- Licensed NCDOI Medicare Supplement/Long Term Care Agent 2008 to present
- Licensed NCDOI Life, Accident, and Health Agent 2007 to present
Timeline
Manager of Medicare & Regulatory Compliance
FirstCarolinaCare Insurance Company
09.2021 - Current
Compliance Auditor
FirstCarolinaCare Insurance Company
05.2016 - 09.2021
Operations Analyst
FirstCarolinaCare Insurance Company
03.2015 - 05.2016
Account Manager
FirstCarolinaCare Insurance Company
12.2006 - 03.2015
Office Manager
Allergy Partners of Pinehurst
06.1994 - 12.2006
Associate of Applied Science - Paralegal Studies
Central Carolina Community College
Bachelor of Science - Accounting
Franklin University
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