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.
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