Kimberly Edwards

Experience

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  Chase Brexton Health Care

  Jan 2001 - Jan 2004

  Operations Manager

  Comprehensive health care provider staffed with physicians, nurses, medical assistants, pharmacist, therapists, psychiatrists, dentists, and case managers.Coordinated multiple provider applications for medical malpractice coverage, commercial insurance plans, Medicaid, MCOs, and various other networks.Managed wide range of operational functions, including procurement, security, and insurance policies and procedures for three Baltimore-area facilities.Implemented complex policy and procedures for credentialing medical staff. Show less

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  Maryland Department of Health and Mental Hygiene - Board of Physicians

  Jan 2004 - Jan 2008

  Compliance Analyst

  State of Maryland Department of Health and Mental Hygiene - Board of Physicians 2004–2008Conducted full spectrum of investigations into allegations of violations of the Maryland Medical Practice Act. Liaised with the Office of Attorney General.Conducted field assignments to substantiate or refute allegations.Prepared legally sufficient cases, subpoenas, correspondence, and packets for Board and Board Panel review.Presented case findings and facts before 21-member Board and Board Panels. Show less

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  Maryland Department of Health and Mental Hygiene - Board of Physicians

  Jan 2008 - Jan 2013

  Lead Compliance Analyst

  Maryland Department of Health and Mental Hygiene - Board of Physicians 2008–2013Department regulates the Maryland Medical Practice Act and investigates complex cases and complaints against physicians and allied health care providers. Produce legally sufficient documents and evidence to support prosecution positions.Introduced new protocol for investigations; adopted as agency wide standard. Oversaw all aspects of investigations of complex cases and complaints against physicians and allied health care providers.Developed and implemented training program that increased charge success rate.Managed and reviewed junior Compliance Analyst’s investigative reports. Show less

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  Maryland Health Benefit Exchange

  Jun 2013 - now

  Agency mandate is to make health insurance accessible to all uninsured Maryland residents by facilitating insight, involvement, and regulatory compliance of qualified plans and insurance carriers. Analyze submitted health care carrier plans - make recommendations for acceptance or denial of plans to management - manage certification process for compliance. Guide the department as Subject Matter Expert for industry standards plan management software (SERFF=System for Electronic Rate and Form Filing).Resolve any and all carrier issues and problems related to plan management policies and operations procedures.Create workflow, plan data management and upload for access.Maintain open, professional communications with other government agencies, private companies, carriers, customers, and vendors. Show less

  • Account Manager

    Jan 2016 - now

  • Business Operations Specialist

    Jun 2013 - now