DAN NGUYEN
Irvine
Summary
Within over 8 years in healthcare insurance, my experience has touched upon many facets of the industry including investigations, compliance and regulatory affairs. The common denominator within these experiences has been an emphasis on ensuring that laws, rules, policy and regulations are adhered to in protecting the company I was employed at and also their members and stakeholders. Whether it is utilizing data mining techniques to detect fraud waste or abuse or interpreting and implementing federal and state mandates, I am eager to apply the knowledge and experience I have gained to my next career venture.
Overview
12
12
years of professional experience
Work History
Sr. Compliance Analyst
Blue Shield of California Promise Health Plan
01.2015 - 01.2021
- From 2015-2019, was the sole marketing material reviewer for the company, overseeing that all member materials complied with State (DMHC) and Federal rules and Center of Medicare Services (CMS) guidelines
- Successfully took lead as project manager in ensuring the company passed the CMS Performance Measure Validation audit two years in a row
- Demonstrated leadership with working and coordinating with several departments within the company an ensuring compliance with CMS and DMHC regulations
- Acted as primary liaison between the company and CMS with submitting all reports and data requests on or before their specified due dates
Pharmacy Auditor
United Healthcare, OptumRx
01.2013 - 01.2015
- Successfully met goal each month of recoupment of $200,000 in erroneous claims
- Not only consistently meeting goal but also exceeding goal pass expectations
- Familiarity in softwares such as AS400 and Realtime
- Fully adept in seeking claims that are fraud, waste or abuse found through data mining techniques
- Conduct on-site audits at pharmacies and long-term care facilities
Pharmacy Technician
Walgreens Pharmacy
01.2009 - 01.2013
- Over six years of experience in retail pharmacy operations which include being responsible for helping pharmacists provide prescription medication and other health-related products to customers
- Duties include:
- Preparing and reconstituting medications in accordance with state laws and regulations
- Maintaining patient records
- Preparing medications for dispensing to patients by packaging products into unit-of-use packaging
- Carefully entering prescriptions and preparing labels in an accurate and timely manner for clinical review
Education
Bachelor of Arts degree - Chemistry
University of California
01.2006
Skills
- Regulatory expertise
- Legal research
- Documentation review
- Policy analysis
- Compliance monitoring
- Technical Documentation Expertise
- Analytical Reporting Skills
- Management of Corrective Action Processes
- Regulatory Compliance
- Proficient in Investigative Analysis
- Regulatory expertise
- Legal research
- Documentation review
- Policy analysis
- Compliance monitoring
- Technical Documentation
- Analytical Reporting Expertise
- Implementation Of Corrective Actions
- Excel Proficiency
Timeline
Sr. Compliance Analyst
Blue Shield of California Promise Health Plan
01.2015 - 01.2021
Pharmacy Auditor
United Healthcare, OptumRx
01.2013 - 01.2015
Pharmacy Technician
Walgreens Pharmacy
01.2009 - 01.2013
Bachelor of Arts degree - Chemistry
University of California
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