sonnia oliva

Led and directly executed core service functions of a regulatory nature that pertained to project development, clinical operations, Medicare/Medicaid provider, manage care contracting, and marketing. Responsible for the development of core and clinical function policies: administration, human resources, compliance, clinical, infection control, workplace safety, ethical, and quality improvement. Responsible for evaluating and maintaining compliance with federal, state and accreditation conditions of participation and standards for continued license and Medicare/Medicaid provider status. Directly involved in Medicare and Medicaid billing compliance by keeping staff educated and auditing/evaluating regulatory billing changes into policy, including federal risk-adjustment methodology updates for accurate reimbursement. Ensured the organization maintained appropriate privacy and confidentiality policies, consent, and authorization forms, to include information notices and materials.

Clinical account management functions to include collaborating and presenting care management program value reports, analysis of program findings to clearly demonstrate program effectiveness to prospective and current clients (employers purchasing health insurance), and respond to Request for Proposals, specifically the development new program value language for new medical management to maintain current business and recruit new business.