SHARMEKA THOMPSON
Wilmington,DE
Summary
Innovative, detail-oriented Compliance Operations Analyst experienced in Medicaid Managed Care Organizations. Passionate about business optimization and workflow improvements. Ready to take on new professional challenges with growth-oriented company.
Overview
20
20
years of professional experience
Work History
Government Compliance Oversight & Risk Analyst
Perform RX
Philadelphia , PA
05.2022 - Current
- Provide oversight of compliance of internal operations and downstream entities with state and federal regulations
- Provide oversight of Corrective action plans (CAPs)and ensure effective tracking of audit outcomes and CAPs
- Perform and monitor audits, risk assessments and document activities ensuring compliance
- Monitor metrics based on regulatory guidance and service level agreements
- Prepare reports communicating results of audit and oversight activities to ensure effective ongoing regulatory compliance.
Compliance Operations Analyst
Amerihealth Caritas Delaware
Newark, DE
03.2018 - 05.2022
- Assist in overseeing/ monitoring compliance of the State of Delaware Medicaid Managed Care Organization (MCO) contract .
- Partners with business areas within ACDE and corporate committees to ensure compliance with state and federal regulations. Investigate, resolve and document findings regarding all compliance issues pertaining to ACDE .
- Investigates , monitors and reports on privacy and security incidences and applicable remediation.
- Collaborate with Corporate Audit, Regulatory Affairs,Corporate Compliance and ACDE on responses to audits .
- Provide guidance and oversight in the review and/or development of ACDE Policies and Procedures in response to audit findings or changes in contractual requirements or regulations
- Develop compliance training and education sessions, as needed, in response to audit findings or changes in contractual requirements .
- Assist in development and monitoring of corrective action plans.
- Assist in implementation of corporate member consent forms for ACDE including education on the use of new forms.
Social Service Administrator
Division Of Medicaid And Medical Assistance
New Castle, DE
04.2016 - 02.2018
- Provide project management and quality oversight of the Health Benefit Manager and the Non-Emergent transportation broker contracts.
- Consistently comply with applicable laws and regulations and ensure Managed Care Organizations adhered to Medicaid regulations.
- Review and interpret applicable Federal and State directives, instructions and guidelines to recommend operational changes for contract compliance
- Represent and interpret the agency's functions and services to other institutions, the public, government agencies and other organizations
- Monitors, evaluates, collects and analyzes program data
- Provide technical assistance and recommends course of action
- Acts as liaison with operations staff, state and federal agencies and community organizations.
Senior Medical Social Work Consultant
Division Of Medicaid And Medical Assistance
New Castle, De
12.2012 - 04.2016
- Provided direct casework services which included emotional and social assessments, problem identification and developed service plan to assist client and family in dealing with medical conditions,
- Allowing medical recommendations and achieving maximum social and health adjustment
- Effectively served as primary liaison and subject matter expert providing information and consultation to the Managed Care Organization (MCO), other state agencies, Centers for Medicaid and Medicare, political and community stakeholders in adherence to the MCO contract and federal and state regulations
- Assisted in resolving and satisfying client requests and internal issues
- Collaborated with health specialists and civic groups to determine community health needs and the availability of services and to develop goals for meeting needs
Senior Social Worker/ Case Manager
State of Delaware
Newark, De
08.2005 - 12.2012
- Conducted intake interviews to assess financial eligibility of families seeking financial, medical or related services from the Division of Health and Human Services
- Provided referral and follow up services to alternative sources to ineligible applicants
- Provided individual and family counseling to clients; obtains and coordinates public, private or community medical, social and therapy services to meet client’s needs
- Maintained comprehensive case records, summaries, statistical, narrative reports and completed required forms
- Conducted on-going monitoring and assessment of service delivery for optimum quality and efficiency.
Education
Bachelor of Science - Human Services / Criminal Justice
Springfield College of Human Services
Skills
- Good working knowledge of the managed care industry
- Good working knowledge of Delaware Medicaid
- Exercise Professional Judgment in all interactions
- Ability to manage multiple priorities simultaneously and consistently meet deadlines
- Strong interpersonal skills
- Process Improvement
Timeline
Government Compliance Oversight & Risk Analyst
Perform RX
05.2022 - Current
Compliance Operations Analyst
Amerihealth Caritas Delaware
03.2018 - 05.2022
Social Service Administrator
Division Of Medicaid And Medical Assistance
04.2016 - 02.2018
Senior Medical Social Work Consultant
Division Of Medicaid And Medical Assistance
12.2012 - 04.2016
Senior Social Worker/ Case Manager
State of Delaware
08.2005 - 12.2012
Bachelor of Science - Human Services / Criminal Justice
Springfield College of Human Services
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