Michelle R. West
Columbia
Summary
Experienced and highly motivated Compliance Analyst and Quality Improvement Analyst with over 10 years in remote and hybrid work environments, specializing in customer experience, healthcare compliance, and quality assurance. Proven success improving customer satisfaction, optimizing CRM systems, and achieving KPI-driven outcomes in fast-paced industries. Skilled in remote troubleshooting, conflict resolution, and managing cross-functional communication using tools like Salesforce, Zendesk, Jira, Slack, and ServiceNow. Passionate about providing high-quality, empathetic support while maintaining strict HIPAA, PCI, and data privacy compliance.
Overview
13
13
years of professional experience
Work History
Compliance Reviewer
Healthcare Management Solutions, LLC
07.2024 - Current
- Perform research and analysis of data obtained for specific Qualified Health Plan Issuers.
- Prepare final reports and exhibits to summarize all findings using cloud-based knowledge audit software; maintaining a 99% accuracy rate.
- Identify findings requiring a Corrective Action Plan and monitor corrective actions.
- Create and maintain reports to support contractual and regulatory compliance.
Compliance & Quality Improvement Analyst
Alliant Health Solutions
12.2014 - 06.2024
- Led licensing and compliance reviews across 250+ provider facilities annually, ensuring 100% adherence to CMS and SC DDSN regulations.
- Evaluated internal operations and risk areas using root cause analysis, leading to a 40% reduction in compliance violations.
- Authored 500+ reports with trend analysis, HEDIS measure interpretation, and benchmark performance metrics.
- Integrated population health data to identify care gaps and inform risk stratification efforts across Medicaid and dual-eligible populations.
Member Services Training & Quality Manager
BlueCross BlueShield of SC
07.2012 - 12.2014
- Directed training programs for 12+ support staff, resulting in a 20% increase in CSAT and 95% FCR scores.
- Collaborated with clinical and non-clinical teams to promote enterprise-wide quality engagement strategies.
- Developed standardized call scripting based on HEDIS outreach goals and quality performance indicators.
- Reported on key staff performance metrics to leadership, using detailed scorecards and Excel-based reporting.
Education
Master of Science - Health Administration
University of Phoenix
Bachelor of Science - Business Administration
Coker University
License - Life Insurance Producer for Life, Health and Accident Insurance
Intellectual & Developmental Disabilities -
National Core
Certified Professional in Healthcare Quality (CPHQ) -
NAHQ
HIPAA Compliance Training -
HIPAA Associates
Microsoft Office Specialist - Excel, PowerPoint
Remote Work & Productivity Essentials -
NCQA Quality Standards Workshop Completion -
NCQA
Skills
- Quality Improvement
- HEDIS
- STAR Ratings
- NCQA Standards
- Performance Measurement
- CMS Compliance
- Process Improvement
- Value-Based Care
- Member Services
- Managed Care
- Population Health
- PIP Oversight
- Risk Stratification
- Regulatory Compliance
- SWOT Analysis
- Training Development
- Project Management
- Audit Readiness
- Appeals & Grievances
- Utilization Management
- Microsoft Office Suite
- SharePoint
- TeamMate
- Zoom
- Smartsheet
- Microsoft Teams
- VPN & Secure Cloud Tools
Software System Expertise
- Microsoft Office Suite
- SharePoint
- TeamMate
- Zoom
- Smartsheet
- Microsoft Teams
- VPN & Secure Cloud Tools
Timeline
Compliance Reviewer
Healthcare Management Solutions, LLC
07.2024 - Current
Compliance & Quality Improvement Analyst
Alliant Health Solutions
12.2014 - 06.2024
Member Services Training & Quality Manager
BlueCross BlueShield of SC
07.2012 - 12.2014
Master of Science - Health Administration
University of Phoenix
Bachelor of Science - Business Administration
Coker University
License - Life Insurance Producer for Life, Health and Accident Insurance
Intellectual & Developmental Disabilities -
National Core
Certified Professional in Healthcare Quality (CPHQ) -
NAHQ
HIPAA Compliance Training -
HIPAA Associates
Microsoft Office Specialist - Excel, PowerPoint
Remote Work & Productivity Essentials -
NCQA Quality Standards Workshop Completion -
NCQA