Compliance And Quality Management resume example with 15+ years of experience

Jessica Claire
, , 609 Johnson Ave., 49204, Tulsa, OK 100 Montgomery St. 10th Floor
Home: (555) 432-1000 - Cell: - - -
Professional Summary

Systematic and meticulous Quality Manager with over 7 years of experience working collaboratively with top leaders and staff to optimize adherence to policies, procedures, standards, and regulations. Extensive experience with Value-Based Care programs, building and deploying health quality metrics, following performance and report metrics to ensure the highest value for both patients and providers. Well-versed in comprehensive analysis of operations, process improvement recommendations and best practice introduction. Managed a variety of projects that promote adherence to laws, regulations, and ethical business practices of Compliance Program. Communicates with leadership, management, and staff, ensuring organization is operating in compliance with all federal and state regulations. Capable of resolving escalated issues arising from operations requiring coordination with other departments. Responsible for conducting Security Risk Assessment, along with managing assessment findings and formulating Corrective Action Plan.

Core Qualifications
  • Evaluating over 100 providers, including 250 staff members across Maricopa County, tracking quality of care provided and performance metrics under various Value-Based Care programs
  • Established metrics dashboard to measure performance by provider and location. Created workflow process for quality assurance and audits, implemented visual management/metrics and audit cycles, resulted in improvement of overall quality score over 55%.
  • Developed Compliance Program; project management related to compliance program design, implementation, as well as audits and process reviews of various operational and clinical areas.
  • Education and training with healthcare providers and staff to implement process and counter measures
  • Ability to comprehend and operationalize Federal and State regulations in its applicable delivery channel, while demonstrating job knowledge and proficiency to monitor, evaluate and improve quality efficiency and appropriateness.
  • Manages multiple quality systems, regulatory compliance, quality assurance with a solutions-focused strategic plan.
  • Work with data analytics and other professionals to design analyses of various clinical, administrative, and key performance indicators.
Professional Experience
07/2014 to Current
Compliance and Quality Management Adventist Health System Fairbanks, AK,

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.
01/2011 to 07/2014
Office Supervisor Medstar Research Institute Charlotte Hall, MD,

Responsible for leadership, direction and managing daily operations of staff at second location.

  • Developed, implemented, and maintained workflow procedures including employee handbook, along with office policies and procedures.
  • Monitored and assigned hospital call schedules for all providers.
  • Scheduled and monitored CME compliance, maintained licensure.
  • Created and executed numerous projects and reports.
  • Maintained Botox authorizations and reimbursement, as well as increased reimbursement amount over 75%.
  • In charge of monitoring incoming patient referrals, scheduling department, and multiple phone lines. Insurance verification provided financial counseling to patients, along with collection up front and patient financial balance phone calls.
01/2005 to 01/2009
Lead Medical Assistant New Millennium Family Medicine City, STATE,

Overseeing all back-office duties documented and executed properly.

  • Including, patient triage, vitals, injections, phlebotomy, EKG, assisting in-office procedures, etc.
  • Exceptional knowledge of immunizations, as well as maintaining data for the Arizona Department of Health Services. Increased overall efficiency tracking scores in the Arizona State Immunization Information System (ASIIS) system over 70% for practice.
  • In charge of maintaining, ordering and price comparing all office and clinical supplies.
  • Performed multiple duties in obstetrics, gynecology, as well as, pediatrics, and general practice.
Expected in 05/2020
Associate of Applied Science: Healthcare Compliance & Regulations
Arizona State University - ,
Expected in 05/2017
Associate of Applied Science: Health Information Technology
Central Arizona College - ,
Expected in
Registered Medical Assistant Certificate:
American Medical Technologists - ,

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Resume Overview

School Attended

  • Arizona State University
  • Central Arizona College
  • American Medical Technologists

Job Titles Held:

  • Compliance and Quality Management
  • Office Supervisor
  • Lead Medical Assistant


  • Associate of Applied Science
  • Associate of Applied Science
  • Registered Medical Assistant Certificate

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