This candidate has 10+ years of compliance experience at large, complex healthcare and life science organizations. The candidate leads a team of professionals engaged in risk assessment, data analytics, hotline management, training, and communications. The candidate has led or sponsored various projects to improve revenue cycle processes, align compliance metrics with executive incentives, and implement systems to expedite incident resolution. Additionally, the candidate has experience preparing for and working under a Corporate Integrity Agreement (CIA).

This candidate is passionate about enhancing the maturity of each compliance program element and increasing the effectiveness of the program through interplay among elements.

This candidate has a Masters of Healthcare Administration (MHA) and is both a Certified Compliance & Ethics Professional (CCEP) and is certified in Healthcare Compliance (CHC).

This candidate’s most recent experience is as a Director of Compliance & Privacy/Security Officer at a non-profit health center with oversight of three community health centers and a mobile unit that provide medical, dental, and behavioral health services. Within this role, this candidate has had the opportunity to oversee the regulatory activities such as, but not limited to provider credentialing, audited claims processing, appeals, grievances, complaints, formulary administration, contract management, fraud waste and abuse (FWA), and board/committee governance.

This candidate has solid knowledge of healthcare related laws and regulations including Stark, Anti-kickback, False Claims Act, HIPAA, as well as HRSA Guidelines.

This candidate is an experienced leader having been the spearhead of several cross functional teams that overhauled organization-wide processes, programs and initiatives leading to better coordination across departments and timelier internal and regulatory reporting. This candidate has overseen small- & large-scale projects aimed at eliminating redundancies, standardizing processes, analyzation of root causes of deficiencies, & process mapping to identify & correct gaps/deficiencies. This candidate revised/revamped Compliance Programs and provides compliance training to all employees at their organization. Additionally, this candidate has experience as Privacy and Security Officer.

This candidate has a Master of Science in Health Informatics, is a Registered Health Information Management Administrator (RHIA) and is certified in Healthcare Privacy and Security (CHPS).

This candidate has 15 years of experience in compliance having served as Medical Auditor, Director of Revenue Integrity and Compliance Officer. This candidate is also an experienced RN with Compact States Licensure.

This candidate has solid knowledge of healthcare related laws and regulations including Stark, Anti-kickback, False Claims Act, HIPAA, EMTALA as well as OIG Work Plans and Federal Sentencing Guidelines. This candidate also has experience working under a Corporate Integrity Agreement.

This candidate is a strong leader having previously managed approximately 60 employees and maintained budgets across several hospital units and was responsible for system wide Joint Commission preparedness in a previous role. This candidate revised/revamped Compliance Programs and provides compliance training to all employees at his system. As Director of Revenue Integrity, this candidate helped in the implementation of changes in the hospital’s Chargemaster as well as identified inconsistencies in the ancillary system interfaces that resulted in a large net revenue increase. Additionally, this candidate has experience as Privacy Officer.

This candidate has a Master of Science in Nursing, is a Certified Fraud Examiner, Certified Professional Coder and is Certified in Healthcare Compliance.

This savvy healthcare compliance candidate has a great depth of experience in Research Compliance with its niche intricacies, and broader experience in general areas of Compliance such as privacy & security including HITRUST certification, Medicare billing investigations and audits, Compliance education and training. This candidate is an adept strategic planner and thoroughly enjoys project management.

This candidate is an experienced leader having been the spearhead of several cross functional teams that overhauled institution & system-wide processes, programs and initiatives leading to better coordination across business units and timelier internal and regulatory reporting. This candidate has overseen small & large scale projects aimed at eliminating redundancies, standardizing processes, analyzation of root causes of deficiencies, & process mapping to identify & correct gaps/deficiencies. The candidate successfully oversaw Lean Six Sigma projects to combine & automate the annual Compliance & Internal Audit risk assessment process which eliminated wasted productivity and nonvalue added activities and projects to implement new complaint management software which standardized and streamlined operational processes, reduced the average number of investigative steps from 16 to 11, permitted data gathering relating to hours dedicated to investigative tasks.

This candidate has an MBA with a concentration in Finance and two Bachelor’s in Mass Communication and Spanish respectively, is certified in Compliance (CHC) and is a certified Clinical Research Compliance Professional (CCRP).

This candidate’s most recent experience is as a Director-Level Regional Compliance & Privacy Officer at a private for-profit health care system with oversight of three community hospitals and geographically affiliated medical practices. Prior experience included work as a compliance resource to business units in the public service consulting and operations division of a public academic health sciences entity and as a consultant in a risk management practice of one of the largest management consultancies in the US.

This candidate has succeeded in the development, growth and implementation of all aspects of an organization’s compliance and privacy program and always aspires to build the strongest compliance and privacy program possible in an environment that supports the same mission. Of particular note, this candidate is experienced in participating in, and leading the completion of, project deliverables in deadline driven environments.

This candidate works diligently to identify and address compliance and privacy risk. This candidate accomplishes this by researching industry insights and regulatory guidance, using program metrics and partnering with organizational subject matter experts. This results in prevention and detection and for supportable decisions and next steps in compliance and privacy matters.

This candidate successfully works with Information Technology, Information Security, Legal, Case Management, Revenue, Program/Clinical Leaders and C-Suite. By reaching out to the right resources and getting to the heart of issues in compliance and privacy matters, this candidate’s versatility enables them not only identify next steps but also to develop a plan and lead the team to implement it.

This candidate has a Master of Public Health and Master of Science in Counseling and Human Relations in addition to certifications in Healthcare Compliance (CHC), Healthcare Privacy Compliance (CHPC), Case Management (CCM), and Counseling (NCC). This expertise has proven particularly effective in policy development, audits, incident investigation in specialized areas like behavioral health.

This dualy experienced healthcare compliance professional is an attorney and a nurse ready to step in and share legal and clinical knowledge to assist healthcare organizations in successfully navigating the complex web of laws, regulations, and guidelines surrounding healthcare compliance. This candidate is adept at interpreting rules and regulations, conducting risk assessments, strategic planning, creating and implementing policies and procedures, training staff and serving as a solutionist for organizations. This candidate has served as the subject matter expert for the Healthcare Effectiveness Data and Information Set (HEDIS) Compliance Audit (Medicare). This candidate is poised and ready to serve as a thought-leader in the area of healthcare compliance with the ability to create innovative and cost effective solutions.

This candidate has a JD, is an attorney and counselor-at-law, has a Master’s Degree in Public Policy MPP, a Master of Divinity MDiv, and is an RN with a Bachelor of Science Degree in Nursing, BSN.

This candidate has 16+ years’ of experience working in a quality improvement or regulatory compliance capacity within a wide variety of healthcare-related industries, including hospitals, managed care organizations, managed behavioral health organizations, private healthcare companies and the Department of Defense’s Bureau of Medicare and Surgery (BUMED).

Within each of these roles, this candidate has had the opportunity to oversee the regulatory activities such as, but not limited to: provider credentialing, audited claims processing, appeals, grievances, DOI & CTM complaints, formulary administration, contract management, agent/broker marketing, fraud waste and abuse (FWA), delegated entity (FDR) oversight, and board/committee governance. In several of roles, this candidate served as the data privacy subject matter expert (SME).

This candidate has a Bachelor of Science in Health Administration with a concentration in Health Management; is a Certified Provider Enrollment Specialist (PESC), DecisionHealth; and is Certified in Healthcare Compliance (CHC), Health Care Compliance Association.

This candidate has a strong background in Compliance with exceptional skills in auditing and investigation, comprehensive training and education, and excellent communications methods that relay pertinent information in a friendly manner. This candidate has consulting experience as well as health system, rehabilitation facility, skilled nursing facility, and physician compliance experience.

Among this candidate’s accomplishments are increasing professional revenue by 100% within 6 months instituting efficiencies within the department processes and developing checks and balances to eliminate unreported billable services.

This candidate has a very well-rounded clinical, financial, and coding background. This candidate holds a CHC, is a CPA, a certified coder and a Licensed Practical Nurse, and earned a green belt in Lean Six Sigma.

This candidate’s career has progressed in Compliance for 15+ years. This candidate’s career in Compliance began as Hospital Compliance Coordinator (Manager). Since then this candidate has held positions as Regional Compliance and Privacy Officer, Divisional Compliance & Privacy Officer, Regional Vice President, Compliance & Privacy Officer and Chief Compliance Officer at health systems and a managed care organization.

This candidate is a collaborative and supportive, hands on leader, looked to as a resource. This candidate is fiscally responsible, has written policies and is a polished executive level presenter.

This candidate has worked under multiple Corporate Integrity Agreements, working with the Office of Inspector General and successfully meeting the requirements of all the CIAs without any further fines or penalties.

This candidate is thorough and adept at audit, and has been able to catch and rectify billing errors, avoiding further auditing by the OIG and avoiding a potential CIA.

This candidate has a deep breadth and depth of experience with hospital contracting and led the implementation of a third party contract management database used for all vendor and referral source contracting, centralizing all contracts under on system which created efficiencies, reduced costs and increased savings for the health system.

This candidate has an MBA, a BA, and is certified in Compliance and in Risk Management. This candidate is also White and Yellow and Green Belt Certified.

This candidate is a high level compliance leader and RN with experience in the health insurance compliance and operations space, as well as on the provider side. This candidate is poised to bring the background and skill gained in managed care, operations and clinical nursing to a provider environment, with the goal of enhancing processes and improving quality and regulatory adherence, to protect and serve beneficiaries/patients.

This candidate is ready to step into position in which there’s responsibility to shape the compliance program, bring ethical considerations to bear where appropriate, provide support and guidance to staff and institute or maintain a collaborative relationship of trust between departments, staff and Compliance so that together excellence in service is provided. This candidate is experienced with start-up compliance programs, as well as those that need to be refocused or overhauled. This candidate is a true leader and especially enjoys mentoring and guiding compliance staff while helping them grow professionally in a collaborative and supportive environment.

In addition to being an RN, this candidate has a Master’s Degree in Health Services Administration and has a CHC.

This candidate is engaging and likable with the skills needed to develop productive key relationships and to quickly improve a culture of Compliance and Ethics. This candidate is currently serving as the Chief Compliance Officer of a health system. In addition to an acute care hospital, this candidate is also responsible for the hospital’s ancillary facilities, skilled nursing facilities, numerous physician practices, Audit, and Enterprise Risk. This individual thoroughly enjoys Health Care Compliance, Ethics, Audit, and Risk Management and would like the opportunity to have increased responsibilities at a larger hospital or system.

This candidate has successfully led efforts to repair the hospital’s culture which was generally fearful and intimidated of reporting Compliance and Ethics matters. That culture existed prior to this candidate’s arrival. When this candidate began the role, the candidate worked with management to implement a Culture of Compliance assessment and strategy. The assessment showed that a sizable number of employees at the organization were fearful of reporting and had faced actual intimidation by supervisors and managers. Over one third of this candidate’s organization did not know how to effectively report a Compliance issue. Within one year, most employees know this candidate by first name, management has become more trusting of Compliance, Compliance reports come in frequently, and the most recent survey showed that the fear of reporting was cut by nearly 50% and the lack of knowledge of reporting cut by over 75%.

This candidate has also reformed a weak Risk Assessment process. This candidate worked with a team to reform the process, roll out an Enterprise Risk System, and identify over 1300 risks in their first assessment. Over 100 high-risk items were identified to fix within 120 days and successfully mitigated. This challenge brought over 30 service lines together to solve problems that could impact the entire system. The candidate’s risk strategy consists of objective, subjective, and ad-hoc identification measures.

This candidate has also been able to successfully digitalize processes in a cost effective manner; obtain the buy-in of leadership in the digitalization of numerous screening processes; and engage in successful operational compliance, ethics, and risk management during times of crisis and significant organizational exposure. These efforts have increased the efficiency of the program, the ability to pull data with a click of a mouse, and has made this candidate a key player in numerous operational areas. This individual continues to work with their team to finds ways to eliminate paper, go digital, and streamline processes while providing value to the organization.

This candidate has a J.D., an MHA, a Bachelor of Arts, is Certified in Healthcare Compliance (CHC), and trained in Lean Six Sigma.

This candidate has a broad depth and breadth of healthcare compliance knowledge and experience including program implementation, upgrading policy, processes and communications, overseeing Code of Conduct and Conflict of Interest programs, privacy, fraud/waste/abuse and investigations as well as experience in the insurance “payer” space. This candidate has experience as a Compliance and Privacy Officer at a large and prominent hospital system and medical group and as Compliance Lead for a large academic hospital system and medical group. Responsibilities included implementing the compliance program, training, overseeing compliance research and reviewing applicable state and local government requirements.

This candidate reduced risks at the system’s teaching hospital through the implementation of a new research compliance initiative and saved costs for the health system through the release of internally developed, effective compliance education solutions.

This candidate has an MBA, and CPCO, CHC, CHP, CHRC and HCAFA certifications.