Ana H Gonzalez, MLS

Experience

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  Blue Cross and Blue Shield of North Carolina

  Aug 2006 - Jun 2014

  Responsible for analyzing, researching, and completing standard appeals and grievances. Address all customer concerns and ensure resolution and satisfaction. • Analyzed standard member and provider appeals and grievances for assigned lines of business, excluding FEP, by reviewing applicable resources (i.e., CMP, Reconsideration/Appeal Manual Contract provisions, legislation, Directors, and NCQA requirements).• Identified and collected appropriate documentation from multiple external sources (i.e., pharmaceutical companies, attorneys, providers, Medicare, and PBMs).• Coordinated with medical directors and other clinical staff to ensure the appropriate decision and the approved outcomes were implemented. • Presented analysis and documentation to the appropriate committee, benefits administrators, and BCBSNC. Leadership, as necessary. • Initiated claim adjustments on individual cases when necessary.• Provided written documentation of case determinations to appellants and all involved parties promptly as required by regulatory mandates and legislation.• Identified trends and high-risk issues to make recommendations to address future exposure.• Identified and took corrective action on appeals or grievances that result from noncompliance with contract provisions, appeal or grievance guidelines, provider contract violations, and medical policies.• Created action plans to educate internal employees on benefit misinterpretation and claim system errors Show less Responsible for all administrative activities and work as a liaison between the clinical staff and other departments. For instance, participated and coordinated with teams in different departments to implement new processes.Managed document processes to ensure the availability of healthcare documentation to the clinical staff• Accomplished end-of-month audit and productivity reports ensuring accuracy and deadlines for Management and Finance Department• Facilitated updates of department processes, policies, and procedures based on the Centers for Medicare & Medicaid Services (CMS).• Trained, precepted, monitored, and evaluated new administrative employees. Show less

  • APPEALS & GRIEVANCES ANALYST

    Mar 2013 - Jun 2014

  • ADMINISTRATIVE SUPPORT

    Aug 2006 - Mar 2013
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  Market America, Inc.

  Jun 2015 - Oct 2018

  Identified field compliance violations of the company's Independent Distributor and analyzed and investigated reports of the Independent Distributor's various activities to ensure compliance with company policies.• Liaise with compliance teams, supporting affiliates globally to ensure appropriate levels of information sharing• Proficient at developing and maintaining detailed procedural processes that reduce redundancy, improve accuracy and efficiency, and achieve organizational objectives• Understanding corporate policies and procedures as well as crucial international regulatory requirements• Prepared and submitted decision letter of Corrective Action to the Appeals Board• Researched and analyzed appeals requests and presented findings and recommendations to the Appeals Board• Maintained investigation records and properly logged activity• Responsible for preparing and implementing case investigation strategy for effective resolutions• Maintained investigation records and properly logged activity to ensure timeliness and accuracy.• Prepared a variety of other written communications, reports, and documents.• Maintained energy and enthusiasm in a fast-paced environment. Show less Responsible for company-wide documentation of processes and procedures from inception to approval. • Conducted in-house company-wide employee audits• Conducted interviews and interpreted job responsibilities to create accurate documentation to reflect processes and procedures• Understanding company regulatory compliance, process conformance, and regulatory related issues• Responsible for the development of compliance assessments• Collaborated with Management and staff to improve and implement identified changes• Translated corporate processes and procedures from English to Spanish for Spanish speaking countries.• Used coordination and planning skills to achieve results according to schedule.• Used critical thinking to break down problems, evaluate solutions and make decisions. Show less

  • Policy & Ethics Advisor

    Oct 2016 - Oct 2018

  • Documentation Specialist

    Jun 2015 - Oct 2016
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  Womble Bond Dickinson (US) LLP

  Oct 2018 - Aug 2019

  Compensation & Compliance Project Administrator

  Worked with firm leadership across multiple offices on talent-related programs, policies, and procedures; compensation and employment plans; and federal contractor compliance requirements. • Conducted reviews of various human resources data and talent programs for federal and regional compliance and provided recommended improvements. · Maintained personnel and independent contractor records, HRIS data, and updates to compensation and compliance regulations· Managed Independent Contractor onboarding process· Assisted in-house attorney development programs· Assisted performance evaluation system and processes· Responsible for Internal Transfer Agreements and Status Change Forms for internal job movement· Maintained attorney bar compliance and diversity requests· Responsible for the EEO and OFCCP reports and audits, as well as Wage & Hour forms and disclosure agreements· Researched and updated salary budget data, compensation surveys, consumer price indices, overtime reports, and other performance metrics· Updated firm job descriptions, titles, and exemption analyses, including a review of job duties as related to title and market data· Assisted with budget processes and survey data. Strategic initiative: ability to identify issues, develop recommendations, and implement solutions· Kept confidential information protected· Identified potential compliance vulnerability and risk areas to develop and implement corrective action plans Show less

• 

  Lincoln Financial Group

  Aug 2019 - Sept 2023

  Support Strategic Sourcing team in developing complex Procurement contracts, including but not limited to contract administration, tracking, analysis, process documentation, and compliance· Daily functions include, but are not limited to, preparing agreements, revising agreements, reviewing agreements for accuracy, loading agreements into the electronic contract system, tracking agreements through the approval process, and working closely with the business unit and legal team to ensure a quality contracting service· Work in parallel with legal team members and business partners to draft, review, and negotiate various contractual agreements - non-disclosure agreements, master professional service agreements, lease agreements, license agreements, software-as-a-service (SaaS) agreements, data protection agreements, etc.· Act as a point of contact for complex contract administration, supplier questions, contract drafting, and contract renewals for all Strategic Sourcing categories· Facilitate preparing complex contract exhibits, including scope, specifications, pricing, and special instructions· Facilitate renewals of more complex contracts ensuring the continuation of service; advise business partners of upcoming contract renewal and renewal options.· Evaluate and monitor service contract performance to ensure compliance with contracted obligations and statements of work; provide support on clarifying contract requirements and resolving conflicts· Identify opportunities to improve supplier cost and internal cost management while conforming with and supporting procurement strategies· Coordinate multiple projects of varying complexity simultaneously and communicate both orally and in writing Show less Performed and delivered routine assignments/projects while leveraging and applying knowledge of the Procurement function's assigned area(s) in administering third-party supplier contracts. This includes contract maintenance, administration, reporting, tracking, and analysis.· Maintained knowledge of current and emerging developments/trends for assigned area(s) of responsibility, assessed impact, and collaborated with management to incorporate new trends and developments in current and future solutions· Promoted and enhanced organizational initiatives by positively influencing and supporting change management and departmental initiatives within assigned area(s) of responsibility· Identified and communicated to management process improvements that reduce workload or improve quality for assigned area(s) of responsibility· Ensured functionality of Contract Management and Contract Compliance modules are fully leveraged in supporting end-to-end contract lifecycle management, including agreement entry, maintenance, administration, reporting, tracking, and analysis· Maintained key accountability for independent review and analyses of identified contracts to ensure pricing and specified terms are appropriately captured and represented in Ariba Contract Management (ACM)· Worked with internal stakeholders in ensuring effective, efficient, and compliant transference of key information in ACM to any up or downstream Procurement systems such that negotiated payment terms and pricing are appropriately adhered to· Collaborated and interacted effectively across internal business lines and teams as part of steady-state and continuous improvement opportunity identification.· Followed all company policies and procedures to deliver quality work· Adapted to workflow changes and implemented continuous process improvements to overcome obstacles Show less

  • Contract Analyst

    Jan 2022 - Sept 2023

  • Specialist, Procurement Contract Admin.

    Aug 2019 - Dec 2021
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  VETERANS ADMINISTRATION HEALTH CARE

  Feb 2023 - now

  Advise management officials on matters pertaining to disciplinary and adverse actions, leave, and performance management issues.• Create case files and draft formal correspondence on disciplinary and adverse actions.• Prepares a variety of correspondence on behalf of the agency to address complex Employee and Labor matters including, disciplinary and adverse actions, settlement agreements, and congressional correspondence.• Advises managers on appropriate disciplinary/other corrective techniques in response to a range of conduct and performance problems; explains rules and procedures to employees and helps them understand their rights and obligations.• Researches and interprets legal and regulatory guidance, including case law, United States Code, Code of Federal Regulations, and VA/VHA Handbooks and Directives.• Provides management with interpretation of policies, procedures, and collective bargaining agreements.• Serves as subject matter expert regarding policies and procedures pertaining to Federal Labor Relations Authority (FLRA) and Federal Services Impasses Panel (FSIP).• Reviews third-party involvement in negotiations and represents the agency in appropriate cases, serves as a point of contact on third party proceedings arising from the labor management programs, such as unfair labor practice charges.• Assist and perform fact finding in connection with unfair labor practice charges and complaints of limited scope and complexity; and evaluate pertinent information and make recommendations for resolution. Show less

  • Human Resource Specialist – Employee Relations/Labor Relations

    Feb 2023 - now

  • Human Resource Specialist – Employee Relations/Labor Relations (ER/LR)

    Feb 2023 - Sept 2023