Valerie Grimes
Experienced Compliance Professional
Summary
Quality-driven Compliance Professional familiar with tracking, documentation and reporting requirements. Assesses work, materials and procedures and recommends adjustments to maintain compliance. Over 15 years of experience in reviewing, understanding and articulating regulations, laws and related court cases associated with industry.
Overview
26
26
years of professional experience
2
2
Certification
Work History
Business Analyst II
Centene Corporation
08.2023 - Current
- Assist Health plans with Provider Adequacy(State/Federal guidelines) based on created data reports
- Participate in Health Plan Adequacy Strategy Market Calls
- Assist Senior Business Analysts with Health Plan Reporting emails
- Participate in document preparation submitted to Centers for Medicare and Medicaid.
Policy Specialist
Centene Corporation-Envolve Benefit Option
06.2020 - 08.2023
- Conducted research on current and emerging issues related to assigned policy areas.
- Identified areas for improvement, narrowing focus for decision-makers in making necessary changes.
- Maintained a comprehensive documentation of current legislation, regulations, and court decisions related to assigned policies.
- Served as a company-wide subject matter expert on policy changes and guidelines to ensure organization policy compliance
- Performed monthly policy audits for timely, compliant submissions.
Regulatory Relations Specialist
Purpose Financial
03.2018 - 01.2020
- Served as central point of contact for state regulatory examinations of Purpose Financial Money Lending business for 15 states
- Summarized and communication State Regulatory examination activities to internal and external stakeholders in accordance with established deadlines
- Implemented monthly Cash Advance Center Social Security Numbers audit ti ensure the integrity of information submitted to State database
Legal and Audit Specialist
Cahaba Safeguard Administrators
04.2006 - 05.2017
- Managed caseload of assigned Medicare audits and desk reviews for healthcare facilities
- Researched Medicare/Medicaid law, regulations and court cases to support audit compliance in preparation for Medicare appeals.
- Prepared detailed reports on audit findings.
- Collaborated with State/Federal Regulators; Attorneys; Healthcare facilities and their representatives for proper understanding of Medicare and Medicaid regulations.
Vendor Liaison
Affiliated Computer Services, Inc.
05.1998 - 04.2006
- Strong knowledge if human resources principles and practices as HR specialist or specialist in one of more of the assigned areas of responsibility.
- Processed employee, retiree and surviving spouse Qualifying Life Events.
- Excellent communication skills with the ability to communicate clearly, effectively, and accurately in verbal and written form
- Experienced in use of HR applications to process, review, monitor and/or report human resource actions and transactions.
- Experienced in benefits, leave administration, and timekeeping polices and procedures
- Collaborated with cross-functional teams for successful completion of projects with external parties.
- Reviewed vendor performance metrics regularly.
- Worked successfully with diverse group of coworkers to accomplish goals and address issues related to our products and services.
- Demonstrated ability to work independently with minimal instruction
- Ability to consistently and effectively interpret and apply a variety of HR policies and procedures.
- Developed, implemented and maintained a series of training manuals and tests used to evaluate new and ongoing members of the call center team.
Education
Master of Arts - Adult Education
East Carolina University
Greenville, NC05.2011
Associate of Science - Paralegal Studies
Meredith College
Raleigh, NC05.2005
Bachelor of Science - Accounting
CUNY-York College
Jamaica, NYSkills
- Operational Reporting
- Workflow Analysis
- Microsoft Office experience
- Customer Service
- Employee Benefits Administration
- Excellent communication skills
Certification
- License Insurance Agent
- Licensed Real Estate Agent
- Health Insurance Associate
Timeline
Business Analyst II
Centene Corporation
08.2023 - Current
Policy Specialist
Centene Corporation-Envolve Benefit Option
06.2020 - 08.2023
Regulatory Relations Specialist
Purpose Financial
03.2018 - 01.2020
Legal and Audit Specialist
Cahaba Safeguard Administrators
04.2006 - 05.2017
Vendor Liaison
Affiliated Computer Services, Inc.
05.1998 - 04.2006
Master of Arts - Adult Education
East Carolina University
Associate of Science - Paralegal Studies
Meredith College
Bachelor of Science - Accounting
CUNY-York College
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