Compliance And Quality Management resume example

Development and management of the organization's Compliance Program, policies, and code of conduct. Responsible for design, training, and implementation of policies and procedures in accordance with Federal, State, and various CMS programs, along with managing multiple private payer Value-Based Care programs.

• Provides strategic direction to providers and staff on Value-Based Care programs to improve quality and progression toward meeting value-based goals.
• Created, managed, and maintained the group's Compliance Program, along with implementing written policies and standards of conduct.
• Conducts internal investigations reported though the compliance/ethics line as applicable. Research, document and investigate concerns or questions related to compliance and regulatory requirements.
• Advanced Compliance Hotline. Developed program initiatives, script, and method to offer employees a secure and confidential reporting avenue.
• Policy development including Compliance Program Manual, Code of Conduct, employee handbook and various website polices.
• Reporting to the Board of Directors on status of programs, recommendations, and ongoing federal and state program requirements.
• Ensure both physicians and staff are educated, trained, and maintain compliance on programs. While executing audits, process reviews and reviewing data to identify opportunities for improvement.
• Develops relative audits pertinent to regulatory requirements. Performing audits utilizing defined audit standards. Conducting research and maintaining awareness of updated laws and regulations.
• Conducts coding, billing and other procedure audits and prepares and presents reports of findings to leadership.
• Assists with the development of corrective actions and monitoring activities to mitigate risk and validate ongoing compliance with government regulatory requirements.