CONSTANCE JONES
Houston,TX
Summary
Detail-oriented Compliance Manager offering 25 years of expertise in risk management, policy development and strategic planning. Advanced knowledge of regulatory compliance with proven track record of partnering with executives and business leaders to identify vulnerabilities and create corrective actions. Collaborative and team-oriented with excellent communication and interpersonal skills to foster strategic partnerships and promote company reputation.
Overview
32
32
years of professional experience
Work History
Executive Senior VP/Chief Compliance Officer
American Caribbean Chamber Of Commerce
Houston, TX
04.2020 - Current
- Managed practical action plans to respond to audit discoveries and compliance violations.
- Enhanced accountability and responsibility for compliance by allocating tasks such as assessments, mitigation, monitoring and auditing.
- Identified potential areas of compliance vulnerability and risk to develop and implement corrective action plans.
- Improved collection process via solicitation and analysis of feedback as well as detailed reporting.
- Gathered, organized and evaluated data to make accurate assessments of current operations.
- Devised hiring and recruitment policies
- Collaborated with legal and compliance teams to review paperwork, obtain feedback and procure available information for new training processes.
Compliance Consultant
CRJ Healthcare Credentialing and Consulting
Houston, TX
01.2002 - Current
- Conduct complete assessment of credentialing process including initial appointments and reappointment applications to ensure compliance
- Review entities credentialing processes for compliance with regulatory agencies (i.e., Joint Commission, Accreditation Association for Ambulatory Health Care-AAAHC, Texas Department of Health-TDH and National Committee for Quality Assurance-NCQA, etc.)
- Provide accurate results (to include Action Plan, if needed) of credentialing files and policies and procedures, medical staff bylaws and rules and regulations
- Develop and/or revise policies and procedures, medical staff bylaws and rules and regulations for contracted entities to meet compliance; create employee procedure manual for credentialing department to ensure credentialing process is consistent
- Provide training of new credentialing staff for newly contracted entities
- Document internal audits and other quality assurance activities
- Follows up for all non-compliant areas until full compliance is achieved
- Prepare contracted entities for accreditation surveys
- Evaluate audit findings and implement appropriate corrective actions
- Collect and compile statistical quality data
- Interact with surveyors of accrediting agencies and complete Corrective Action Plans.
- Created policies and programs to encourage managers and employees to report suspected fraud and other improprieties without fear of retaliation.
- Scheduled and conducted evaluations of company policies, procedures and internal control structures.
- Improved company policies and standards to outline ethical, safe and efficient procedures.
- Drove system improvement efforts from concept to completion while strategically managing outside vendors.
- Managed quality programs to reduce overdue compliance activities.
- Wrote and presented reports outlining findings and recommendations from compliance audits.
- Reviewed contracts for compliance and privacy-related issues.
- Established and cultivated productive relationships with regulatory bodies.
- Oversaw proper maintenance and dissemination of filing documentation as well as records and reports for review by various departments.
- Gathered, organized and evaluated data to make accurate assessments of current operations.
- Identified potential areas of compliance vulnerability and risk to develop and implement corrective action plans.
Compliance Coordinator
Harris Health Systems
Houston, TX
01.2019 - 01.2020
- Review and enforce compliance with standards or regulations imposed by state and federal laws, policy and procedures as well as company’s internal guidelines
- Make recommendations to management of noncompliant clinics, hospital and schedule future audits to monitor progress and adherence
- Maintain all function areas of organization, prepare reports for templates and maintain efficient compliance database and identify any risk in same
- Supporting various departments by collecting and coordinating internal compliance data with auditors and various departments
- Maintains open communication for purposes of input, problem solving, implementation and prevention of duplication.
- Promoted compliance by advising management on needed or prohibited actions to comport with government regulations.
- Compiled internal information for compliance audit by reviewing company policy documentation, non-compliance reports, and investigations into questionable conduct.
Medical Staff Manager/Credentialing Manager
WESTSIDE SURGICAL HOSPITAL
Houston
01.2013 - 01.2016
- Responsible for medical staff credentialing process to ensure accuracy, timeliness, and confidentiality
- Processed medical staff initial appointments and reappointment applications
- Credentialed for approximately 425 providers
- Provides oversight in regulatory compliance, credentialing and privileging for hospitals professional and allied health staff
- Assists in formulating directory and implementation of policies, procedures, and regulations
- Keeps abreast of applicable regulatory guidelines and interprets for medical staff, administration, and departments within hospital
- Serves as liaison between medical staff and administration
- Assist with accreditation survey preparation for medical staff/leadership function, including staff and medical staff education regarding accreditation standards
- Develop, recommend, and monitor corrective and preventive actions
- Monitors flow of information from Medical Executive committee and Governing Board
- Assures Medical Staff Bylaws, Rules and Regulations are revised and maintained as necessary
- Works closely with medical staff leaders, administration and risk management regarding medical staff issues
- Maintains open communication for purposes of input, problem solving, implementation and prevention of duplication.
- Increased operational efficiency by developing improved filing systems for confidential client records and reports
Credentialing Auditor / Senior Delegation Auditor
HARRIS COUNTY HOSPITAL DISTRICT
01.2002 - 01.2008
- Manage and carry out delegated credentialing activities for assigned territory conduct pre-assessment and annual delegation audits on potential and/or existing delegates.
- Perform quality review of all credentialing files to ensure completion and accuracy
- Exercises independent judgment and plans credentialing guidelines, determines eligibility against plans’ credentialing requirements
- Perform exit interviews with delegate contacts (for all audits) to communicate all audit findings prior to departure of audit site; provide written communication of audit findings to delegates within specified period
- Provide summary of audit findings to DOC (Delegation Oversight Committee) ensure delegate corrective action plans are completed within contractually identified time frames (to include all data and follow-up documentation
- Ensure all delegates submit required documentation (reports, rosters, etc.) to meet compliance as specified in Standards of Delegation
- Requests additional information as needed
- Explains contractual responsibilities and agency responsibilities to providers
- Implemented current policies to ensure URAC Accreditation and maintenance of TDI/NCQA standards are carried out for consistent compliance
- Manage correspondence (written and telephone) includes opening mail, forwarding high priority mail in timely manner, assisting in setting priorities
- Establishing record system of paid invoices in organized fashion
- Generate reports monthly/upon request of expenses and money outlay.
- Developed and implemented performance improvement strategies and plans to promote continuous improvement
- Actively listened to customers' requests, confirming full understanding before addressing concerns
- Developed team communications and information for meetings
Education
Degree - Business/Public Health Administration
National American University - Rapid City
Rapid City, SDGalena Park High School
Galena Park, TX05.1983
Business Administration And Management
BARCLAY CAREER SCHOOL
Houston, TX08.1990
Skills
- Investigations skills
- Document review
- Federal and state regulations
- Policy analysis
- Compliance documentation
- Risk analysis
- Internal Audits
- Information gathering
- Audit Support
- Quality controls
Accomplishments
- Awarded 2020 International Phenomenal Woman
- Featured in Empower Woman Magazine for my work as an advocate for women's healthcare rights.
- Member of Texas State Force regarding Maternal Morbidity Policy and Legislative Steering Committee
Affiliations
Greater Houston Society for Medical Staff Services
Texas Society Medical Staff Services
National Association for Medical Staff Specialists
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Timeline
Executive Senior VP/Chief Compliance Officer
American Caribbean Chamber Of Commerce
04.2020 - Current
Compliance Coordinator
Harris Health Systems
01.2019 - 01.2020
Medical Staff Manager/Credentialing Manager
WESTSIDE SURGICAL HOSPITAL
01.2013 - 01.2016
Compliance Consultant
CRJ Healthcare Credentialing and Consulting
01.2002 - Current
Credentialing Auditor / Senior Delegation Auditor
HARRIS COUNTY HOSPITAL DISTRICT
01.2002 - 01.2008
Degree - Business/Public Health Administration
National American University - Rapid City
Galena Park High School
Business Administration And Management
BARCLAY CAREER SCHOOL