Rita J. Garabedian
Las Vegas,NV
Summary
Focused compliance advisor with several years of experience managing regulatory reports, audits, and resources to meet regulatory requirements. Flexible and adaptable with superior communication, relationship management, and influencing skills. Proven history of identifying issues, acquiring data, and drawing conclusions to support resolution. Highly driven in member quality care and applying organizational mission to everyday tasks.
Overview
8
8
years of professional experience
Work History
Compliance Advisor II
LA Care Health Plan
06.2022 - Current
- Guided regulatory requirements and identified potential areas of non-compliance.
- Conducted risk assessments, gap analysis, root cause analysis and other activities to identify areas of improvement in the organization's compliance processes.
- Prepared reports for executive management regarding risks, audit results, and trends in non-compliance areas.
- Facilitated communication between departments within the organization regarding changes in regulations.
- Facilitate cross-functional teams, including internal business units and external entities, to ensure data accuracy and meet all requirements.
- Responsible for 35+ regulatory reports, which include timely submission and quality review.
- Assist with collecting and reviewing audit report deliverables for the annual DHCS Medical Audit.
- Collaborated with external stakeholders, such as DHCS, CMS, and Advent, to ensure that all necessary information is shared accurately for both reporting and audit purposes.
- Created work plans and different logs related to process improvement opportunities within regulatory reporting.
- Co Audit Lead for the MDV Audit and managed all Part C Data Reporting implementation.
- Partnered with diverse management teams to recognize and address potential risks.
Quality Lead Authorization Technician
LA Care Health Plan
08.2018 - 05.2022
- Analyzing the business needs of each UM, as well as compliance and quality functions.
- Designing reports to assist management with ad hoc regulatory requests.
- Main UM Quality Lead in designing, testing, and approving reports for new system implementation.
- Ability to translate regulatory requirements into operational guidelines.
- Audit preparation for DHCS, DMHC, CMS, and NCQA.
- Project specialist for all quality report needs, with the preparation of staff training.
- Auditing processed authorization to verify cases are approved per guidelines.
- Case review for timeliness to ensure compliance turnaround times are met.
- Staying current with policies and procedures for both State and Federal guidelines.
- Updating staff on regulatory policy changes.
- Maintaining positive communication between UM Quality and Operations management.
- Identify issues and create proper training documentation for the operations team.
- Report card preparation for clinical and non-clinical staff, based on quality review.
Authorization Technician
LA Care Health Plan
04.2016 - 07.2018
- Creating authorizations based on eligibility and PPG delegation.
- Proficient in HCPC and ICD-10 coding.
- Processing authorization for outpatient and inpatient services.
- Collaborated with fellow team members to ensure compliance standards were met.
- Cross-trained in case management, CBAS, and long-term care processes.
- Created and finalized job aids for day-to-day processes.
- Trained new employees on proper standards and daily workflow expectations.
- Built a professional relationship with providers and vendors to obtain additional information needed during review.
- Determining if a request needs to be sent to a nurse for clinical review, based on medical guidelines.
- Confirming members' eligibility and determining payer of services.
- Part of the Telecommuting team and worked after business hours to ensure member care was not delayed.
- Processed one-time agreement contract with a non-contracted provider.
Education
Master of Health Administration -
University of Southern California
05.2025
Bachelor of Health Management -
University of Phoenix
04.2022
Skills
- CPT/HCPC & ICD 10 Codes
- Communication Skills
- Problem-Solving
- Attention to Detail
- Audit Preparation
- Member Care Focused
- SyntraNet
- Tableau
- QNXT
- QMEIS
- SharePoint
- Compliance Monitoring
- Audit management
- Documentation Review
- Operations Support
- Regulatory knowledge
Timeline
Compliance Advisor II
LA Care Health Plan
06.2022 - Current
Quality Lead Authorization Technician
LA Care Health Plan
08.2018 - 05.2022
Authorization Technician
LA Care Health Plan
04.2016 - 07.2018
Master of Health Administration -
University of Southern California
Bachelor of Health Management -
University of Phoenix
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