Sixteen (16) + years of audit/compliance experience in operational/finanClairel/Sarbanes-Oxley Act (SOX 302 & 404)/Medicare & Medi-Cal reimbursement & compliance audits for government contracting, consulting (public accounting), insurance, manufacturing, and healthcare industries. Extensive background in all stages of audits, including: planning, risk assessment, data gathering and analysis, evaluation, testing of controls, reporting, and follow-up. Exceptional knowledge of audit procedures, including planning, techniques, test and sampling methods involved in conducting various types of audits. Proficiency in using Computer Aided Audit Tools (CAATs) such as Audit Command Language (ACL) software. Experience in identifying and evaluating risks during review and analysis of System Development Life Cycle (SDLC), including design, testing/QA, and implementation of systems (e.g. User Acceptance Testing (UAT) review). Experience in testing the End-User Computing (EUC's) tools. Extensive experience in conducting company-wide fraud risk assessment, fraud investigations, and Self-Assessment Surveys. Experience in evaluating various risks, vulnerabilities, threats, outcomes, probability, risk impact, and risk score-all are used in creating a 'HIPAA Entity-Level Risk Assessment' as well as Risk Assessments for systems that house ePHI. Knowledge and use of claims payment principles and coding structures. Familiar with PhysiClairen Practices' Billing and Coding procedures/processes, including: claims "scrubbing"/submission and AR & denials management. Familiar with the JCAHO's (Joint Commission on Accreditation of Healthcare Organizations) Hospitals & Ambulatory Care Standards and JCAHO's Survey process. Thorough knowledge of Medi-Cal Documentation Standards related to mental health records. Thorough knowledge and implementation of OIG's 7 Elements of a Compliance Program. Extensive experience in assessing risks and monitoring/resolving of issues in these following areas: Accreditation and Clinical Compliance, Infection Prevention and Control, Patient Relations, Quality Measurement, Performance Improvement, and Clinical Risk Management and Patient Safety. Familiar with the Lean / Six Sigma Process Improvement Models; JCAHO's Quality Measures Reporting/National Patient Safety Goals; Reporing of Hospital Quality Indicators/Measures/Outcomes; Patient Satisfaction Measures (HCAHPS' Survey); JCAHO's Hospitals and Behavioral Health Organizations' Standards. Working knowledge of the HIPAA Privacy & Security Rules.