TANYA PROFANCIK
Summary
Highly skilled professional with expertise in business operations, processes and procedures. Proficient in management and analysis of complex medical cases and regulatory compliance. Exceptional office management and customer relationship skills; strong analytical, organizational, and research abilities. Extremely detail-oriented and resourceful in completing projects; able to multi-task effectively. Solid interpersonal skills with the ability to contribute as a team player and interact with professionals on all levels.
Overview
16
16
years of professional experience
Work History
Grievance Program Manager
Baptist Health Care
08.2018 - 06.2023
- Managed and oversaw the grievance and complaints processes, ensuring timely and accurate resolution of complaints and grievances in accordance with state and federal regulations, as well as company policies and procedures.
- Conducted investigations and reviews for all patients filing quality of care complaints in adherence to Joint Commission, DNV and CMS standards and guidelines.
- Ensured all complaints are handled efficiently, collaborating with department leaders within the organization and within mandated time frames as required by our regulatory/contractual obligations, to ensure the timely resolution of all grievances and rebuttals, both internal/external investigations to resolve all complaints expeditiously adhering to all procedures/protocols.
- Developed and maintained procedures and guidelines for handling customer grievances and complaints, including proper documentation, investigation, and resolution.
- Served as the primary contact for regulatory agencies and insurance carriers regarding customer grievances and complaints, ensuring prompt and professional communication.
- Assisted in decisions regarding patient billing adjustments and service recoveries and actively involved in the risk management patient/family disclosure and resolution program.
- Developed and delivered training programs for staff to ensure understanding and adherence to grievance and complaints processes, as well as regulatory requirements.
- Logged, tracked, and aggregated complaints data to ensure data integrity and appropriate identification.
- Analyzed complaint data to identify trends and areas for improvement.
- Facilitated the Corporate Grievance Committee which provides oversight and guidance for process improvements based on identified trends, achievement of goals, and case reviews, as needed.
- Monitored changes in state and federal regulations related to grievance and complaints processes, updating company policies and procedures as needed.
- Served as the subject matter expert and lead on grievance compliance.
ADA Coordinator
Baptist Health Care
06.2016 - 06.2023
- Ensured that the needs of people with disabilities are addressed in the programs, activities and services operated by the health care organization.
- Educated, coordinated, and monitored compliance with Title VI Civil Rights Act, Section 504 of the Rehabilitation Act, ADA regulations and state civil rights requirements regarding discrimination based on disability.
- Oversite and implementation of discrimination complaints and grievance procedures including the investigation of complaints.
- Created and managed communication policy and procedures, service animal policy and procedure.
- Developed ADA guideline reference as a resource used corporate wide.
- Oversite of contracts and relationships with translation services, limited English proficient and sign language interpreters.
- Developed transition plan for ADA accessibility based on 2010 Standards for Accessible Design.
- Worked closely with facilities to maintain compliance with ADA standards.
- Served as the organizations subject matter expert in ADA compliance.
Operations Service Manager
Disability Determination Services
02.2016 - 06.2016
- Reviewed and analyzed case files to ensure compliance with Social Security law and regulations with timeliness targets for each examiner's caseload.
- Monitored management reports on the expenditure of funds to ensure cost effectiveness.
- Coordinated training for new and experienced claims examiners in the unit.
- Reviewed and studied publications of Social Security and State agencies pertaining to the program to maintain up to date knowledge of new developments and changes in medical and vocational aspects of disability.
- Monitored examiners performance and provided feedback for improvement.
Senior Adjudicator
Disability Determination Services
01.2012 - 02.2016
- Conducted telephone interviews to obtain case specific information pertinent to the claimant's cased other relevant medical evidence from acceptable sources.
- Conducted telephone interviews to obtain case specific information pertinent to the claimant's case.
- Reviewed and summarized medical and non-medical evidence to describe information that relates to medical impairment.
- Scheduled claimants for various examinations so that cases may be fully developed to the point where a decision can be made.
- Obtained vocational information from claimants and former employers to write vocational analyses to assess whether claimants can return to past relevant work or determined if the claimants had the capacity to perform other work based on medical restrictions.
- Worked and coordinated with agency medical and psychological staff to arrive at a determination and to obtain residual functional assessment.
- Finalized claim review results by following agency policy and Social Security disability regulations and completing forms, data base information, and notices to claimants of the decision.
- Managed an extensive caseload utilizing organizational skills and time management skills efficiently to maintain caseload.
- Mentored and trained new employees.
- Review adjudicator's cases for accuracy.
- Knowledge of Social Security disability rules, regulations, policies, and procedures.
- Knowledge of medical terminology, procedures, anatomy, and disease processes.
Marketing Manager
Retail Alliance
06.2007 - 12.2011
- Created company brand messaging, collateral materials, customer events, promotional strategies, and product commercialization.
- Provided marketing consultation services to independent retail owners to help them achieve their business goals.
- Designed layout, created content, and edited monthly newsletter and weekly e-newsletter.
- Created all marketing materials for events and seminars as well as invitations, logos, and program books.
- Created and managed annual membership directory.
- Developed holiday campaign with local retail businesses to raise money for local charities.
- Updated and managed website with content management tools.
- Oversight of marketing events including supervision of event coordinator who was responsible for planning social events for area businesses.
- Maintained documentation, detailing assignments, in-progress work and completed project milestones.
Education
No Degree - Nursing Prerequisites
Tidewater Community College
Norfolk, VA05.2010
Bachelor of Arts - Communications And Marketing
The University of West Florida
Pensacola, FL05.2005
Skills
- Conflict Resolution
- Investigation Skills
- Risk Identification
- Law and Statute Compliance
- Manage Contracts
- Data Privacy
- Communication
- Time Management
- Interpersonal Skills
- Critical Thinking
- Train Employees
- Verbal and Written Communication
Timeline
Grievance Program Manager
Baptist Health Care
08.2018 - 06.2023
ADA Coordinator
Baptist Health Care
06.2016 - 06.2023
Operations Service Manager
Disability Determination Services
02.2016 - 06.2016
Senior Adjudicator
Disability Determination Services
01.2012 - 02.2016
Marketing Manager
Retail Alliance
06.2007 - 12.2011
No Degree - Nursing Prerequisites
Tidewater Community College
Bachelor of Arts - Communications And Marketing
The University of West Florida
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