TINA SUTTON-MACK
HEALTHFIRST
Freeport,NY
20
years of professional experience
Experienced with leading teams to achieve project goals through effective management and strategic planning. Utilizes strong organizational and communication skills to foster collaboration and drive performance. Track record of successfully overseeing project execution and adapting to dynamic work environments.
Work History
REGULATORY AFFAIRS TEAM LEAD (SUPERVISOR)
10 Years- Supervised a team of 8 complaint analysts responsible for review and response to State agencies.
- Review and approve communications to Regulatory agencies. Including DFS complaints, Fair Hearing compliance letters to DOH OAG letters, CMS responses and other communications as needed.
- Evaluate trend analysis and collaborate with internal stakeholders to decrease the number of complaints received by NY State and local government Regulatory agencies.
- Assisted internal stakeholders in developing new processes to enhance company-wide solutions, maintaining 4-star NYS Medicaid and 3.5-star Medicare ratings.
- Oversaw the submission of reports to government agencies.
- Led development projects for new audits and provided maintenance on established audit processes.
- Tracked quality assessment scores and provided feedback to improve processes and ensure network quality.
- Conducted focused audits to prepare for regulatory site visits.
- Prepared accurate details and timely monthly quality reports for all data entry and Quality Assurance staff.
- Ensured quality standards were met for Medicaid, FHP, CHP, and Medicare.
- Facilitated communication between Sales, Regulatory, and Product Management departments to coordinate enrollment processes. between Sales, Regulatory and Product Management departments.
TEAM LEAD
9 Years 8 Months- Oversee and participate in department compliance, quality improvement and training initiatives regarding new regulations.
- Performed internal quality assurance audits of operational processes for employees and outsourced vendors, ensuring adherence to policies, procedures, and quality standards.
- Identified defects and improved departmental performance by supporting quality, operational efficiency, and production goals.
- Provided recommendations to enhance controls, improving compliance measures and operational effectiveness.
- Analyzed data to recommend process improvements, contributing to enhanced operational performance.
- Presented results of investigations to senior staff and prepared written reports concerning Special Investigation Unit activities.
- Executed quality improvement audits to assess compliance with established standards.
- Conducted regular performance evaluations, providing constructive feedback to improve team effectiveness.
- Managed a team of 12 analysts, responsible for handling 30+ complaints daily.
Education
No Degree - Business
Skills
Regulatory compliance
Medicaid compliance Regulatory communication
Audit oversight
Quality assurance
Quality improvement
Risk management
Proficient in Microsoft Office Suite
Windows XP
DFS
CCMS
Market Prominence
Right Fax
MACESS
FE Tracking System and Internet usage.
Attention to detail
Team leadership
Conflict resolution
Timeline
REGULATORY AFFAIRS TEAM LEAD (SUPERVISOR)
HEALTHFIRST
10.2013 - 10.2023Read More
TEAM LEAD
Healthfirst
02.2004 - 10.2013Read More
Long Island University
No Degree from Business
Read More