This healthcare compliance professional is a licensed healthcare attorney and certified compliance professional (CHC) with extensive provider-based counsel and Chief Compliance & Privacy Officer experience. This candidate has over nine-years of direct hospital experience serving in various capacities; including Compliance & Privacy Officer and Compliance Counsel roles with for-profit and not-for-profit health systems; ranging from a 900 bed multi-site, multi-hospital health system (including trauma, behavioral health and outpatient diagnostic settings), to nationally recognized medical centers.

This candidate is an expert in compliance program development, implementation and management. The candidate provides counsel on complex corporate transactions, federal healthcare program requirements and reimbursement models, physician contracts, accountable care organizations, healthcare fraud & abuse, telemedicine, and patient and privacy regulations.

In addition to having a Juris Doctorate (JD Health Law Concentration and certification with honors), and a certification in healthcare compliance (CHC); this candidate also has a Bachelor of Arts, B.A. in Sociology.

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 is an energetic attorney who has served as both a General Counsel and a healthcare Compliance leader. This candidate is ready to step into a General Counsel role or join a Compliance team at a health system with a fast-paced, team-oriented culture. This candidate can handle a significant work load and is especially adept with business transactions and the regulatory risks associated with them. This candidate also has Private Equity experience. This candidate enjoys continued professional growth, both personally and assisting others to grow in their career paths, and working on a team as either a leader or collaborator.

While serving as a hospital Chief Compliance Officer, this candidate successfully defended a joint DOJ/OIG criminal/civil action against the hospital and several key executives. During that time, this candidate built and successfully implemented an effective Corporate Compliance Program for the main hospital entity and all of its affiliated entities, and avoided a CIA.

In addition to being an attorney, this candidate also has an MBA and a Black Belt Certification 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 bright and accomplished healthcare compliance professional with well-rounded experience overseeing compliance in hospitals, physician groups, third party billing companies and ambulatory services. This candidate is currently serving as Compliance Officer at a large health system, overseeing multiple entities. This candidate also has a great breadth and depth of experience overseeing tertiary/quaternary medical center (4500+ employees), Revenue Cycle Services/Patient Contact Center (2000+ employees) and Ambulatory Surgery Centers (700+ employees spanning a several locations).

This candidate enjoys leading teams and growing programs, particularly at their early stages, as the candidate feels it provides an opportunity for growth. This candidate also enjoys leading mature programs as it enables the candidate to work on effectiveness while fostering a culture of ethics and compliance!

Among this candidates accomplishments was recapturing over $400K in revenue by identifying a coding opportunity within a hospital department, bridging the gap between Revenue Cycle, Coding & Operations and correcting the coding where significant write-offs were occurring.

This candidate has a Bachelor of Science in Business Administration and a CHC Certification.

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 likeable 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 currently serves as Market Compliance and Privacy Officer with a system consisting of six hospitals, four large physician group practices and several ancillary facilities.

This candidate enjoys being responsible for the development, growth and maintenance 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.

This candidate works diligently to increase the visibility of compliance/privacy: Reporting of incidents has increased by more than 500% at each facility that the candidate has worked at. This candidate accomplishes this by using an old principle called MBWA (management by walking around) which allows the staff to get to know the candidate. This candidate uses these opportunities to educate subtly and to create positive relationships so that people know who to contact with questions and concerns and are not afraid to do so.

This candidate also sets high standards for the organization so that risks are mitigated to the greatest degree possible. This candidate prefers to grow the compliance program using CIA guidance. As CIA guidance changes, this candidate implements those elements that make sense and are applicable to the organization that the candidate works for.

In the audit programs that this candidate has developed, they audit across the spectrum, not just seeking overpayments but any mis-billings, to include those that were missed opportunities. This candidate also advocates the use of data mining to audit efficiently and effectively.

This candidate has an MBA and a Bachelor of Science Degree in Technical Management. This candidate is certified in Healthcare Compliance.

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.

This candidate is well-seasoned with a great depth and breadth of experience in compliance, audit, finance and operations that is receptive to interim positions. The candidate has large healthcare system experience coming from a 5 hospital system with approximately 2,000 beds where the candidate was responsible for the Internal Audit and Compliance functions for multiple hospitals within the system as well as the Physician Organization and a Research Enterprise. The candidate managed a large staff including two directors, a manager and a research auditor and was responsible for the dotted line supervision of locational compliance & privacy officers and chaired the System Executive Compliance Council.

This candidate has a proactive service approach to compliance and audit and has the ability to obtain the support of senior management in the implementation of the compliance program which has resulted in improved efficiency, reduced costs and potential liabilities are avoided. With this candidate’s active listening skills and practical approach the candidate is also able to obtain the support from physician leadership and the General Counsel.

In addition to being a CPA, this candidate also has an MBA with an emphasis in Accounting and Finance and a BA in Business Economics.