Theresa Wheathers
Raleigh,NC
Summary
Experienced Quality Control and Buisness Analyst professional with over 15 years of expertise in leadership, driving operational excellence, and compliance with healthcare enrollment systems. Proven leadership skills, leading cross-functional initiatives, enhancing process efficiency, and fostering stakeholder collaboration. Highly skilled in developing and executing documentation strategies, streamlining workflows, and managing CSR implementations. Known for critical thinking, adaptability, and a strong commitment to service delivery standards. Ready to bring strategic insight and team leadership to a supervisory role in Provider Enrollment operations.
Overview
14
14
years of professional experience
Work History
Business Analyst
GDIT
Raleigh, North Carolina
02.2023 - Current
- Collaborated with stakeholders to gather and analyze business requirements.
- Developed process maps to identify inefficiencies and streamline operations.
- Created detailed documentation for business processes and system functionalities.
- Lead in the implementation of new CSR solutions across departments.
- Analyzed existing systems and processes to identify areas of improvement.
- Prepared documentation summarizing findings from stakeholder meetings and workshops.
- Analyzed data trends to inform decision-making and project planning.
- Managed projects and served as primary liaison between client and multiple internal groups to clarify goals and meet standards and deadlines.
Provider Enrollment Buisness Analyst
GDIT
Raleigh, North Carolina
03.2019 - 02.2023
- Ensured timely resolution of NCMMIS provider enrollment appeals with accurate reporting.
- Represented GDIT in DHB-facilitated appeals hearings, presenting enrollment decisions and supporting program integrity.
- Developed and maintained Provider Enrollment Operations Manual, Policy Interpretations, and Desktop Procedures, delivering clear and compliant technical guidance.
- Supported NCQA CVO Certification initiatives by assisting with surveys, audits, and continuous quality improvement efforts, implementing targeted quality control strategies that enhanced departmental operations.
- Demonstrated agility in responding to evolving compliance requirements and operational demands.
- Managed the NCMMIS provider enrollment appeals process, ensuring accurate reporting and timely resolution.
Internal Control Analyst Associate
CSRA
Raleigh, North Carolina
05.2013 - 03.2019
- Ensured compliance with state guidelines through quality control support for Non-Pharmacy Prior Approval Department within NCTracks.
- Authored and updated Operations Manual and desktop procedures to enhance operational consistency.
- Developed workflow processes that improved efficiency across departmental functions.
- Tracked and resolved SLA defects in SILK system, ensuring timely remediation of issues.
- Conducted monthly audits evaluating staff performance and identifying improvement opportunities.
- Reported audit trends and training requirements to management, supporting continuous quality enhancement.
- Monitored staff performance to ensure consistent adherence to service level agreements.
- Compiled data for weekly and monthly reports, informing leadership on decision-making.
Data Entry Team Lead /Interim Supervisor
CSC
Raleigh, North Carolina
03.2011 - 05.2013
- Provided strategic leadership support to the NCMMIS NCTracks Provider Enrollment Department, driving operational excellence in data entry processes
- Oversaw monthly quality control reviews for both new hires and tenured staff, ensuring adherence to performance standards
- Addressed and processed provider and client requests, maintaining high standards of service delivery
- Created and maintained comprehensive job aids and desk procedures to support staff development and consistency
- Participated in documentation review of Customer Service Requests (CSRs), contributing to quality assurance efforts
- Assessed employee performance and developed individualized improvement plans, fostering a culture of accountability and growth
- Led new hire training and orientation programs, verifying completion of onboarding checklists and essential training documentation
Education
Web & UX Design
Wake Technical Community College
Raleigh, NC07.2025
Project Management
Udemy
Skills
- Critical Thinking
- Problem Solving
- Leadership
- Microsoft Office Suite
- SharePoint
- Multitasking and organization
- Verbal and written communication
- Process improvement
- Project management
- Stakeholder communication
- Agile methodologies
- Internal auditing
Timeline
Business Analyst
GDIT
02.2023 - Current
Provider Enrollment Buisness Analyst
GDIT
03.2019 - 02.2023
Internal Control Analyst Associate
CSRA
05.2013 - 03.2019
Data Entry Team Lead /Interim Supervisor
CSC
03.2011 - 05.2013
Web & UX Design
Wake Technical Community College
Project Management
Udemy
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