Seasoned Healthcare Compliance professional with 10+ years of experience working collaboratively with Executives and staff to optimize adherence to policies, procedures, standards and regulations. Well-versed in comprehensive analysis of operations, process improvement recommendations, policy development, training management and reporting. Well-organized and systematic with excellent communication and planning abilities. Looking for challenging position in fast-paced environment.
Detail-driven Compliance professional focused on maximizing company compliance with applicable laws and standards. Knowledgeable about internal controls, process evaluations and procedural reviews.
Highly skilled in managing and leading health care compliance integrity programs and measuring organizational compliance effectiveness to prevent, detect and correct non-compliance and identify potential fraud, waste and abuse.
Expertise in accreditation for NCQA, and URAC requirements. Experience in pharmacy benefit management programs including, Medicare Advantage, Medicare-Medicaid Plan (MMP) and Dual Eligible Special Needs Plans (D-SNPs). Quality Improvement, CMS STARs Ratings, and HEDIS requirements. Experience in Provider Credentialing, CMS audits reviews and regulations including, OIG audits, managed care regulations, participating in provider contract agreements, HIPAA privacy, and Third-Party Administration (TPA) laws.
Familiarity with operational, financial, and HR procedures and regulations. Proficient in Microsoft Word, Excel, and PowerPoint.
Certified HealthCare Compliance (CHC)
HealthCare Risk Management (CPHRM)
Patient Safety (CPPS)
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