Well-organized and detail-oriented Compliance Officer with expertise in regulatory compliance, audit procedures, project oversight and risk management. Excellent history of delivering effective leadership and training to support staff development. Driven and strategic with an aptitude for program management. Advanced knowledge of audit methodologies, functions and compliance teams.
Overview
25
25
years of professional experience
1
1
Certification
Work History
Compliance Officer
International Community Health Services
Seattle, WA
05.2021 - Current
Compliance Officer for a Federally Qualified Health Center, including school-based health clinics, PACE Program, and Healthy Aging and Wellness Programs
Recruit, hire and oversee team of personnel maintaining the organization's Compliance Program.
Chair of Corporate Compliance Committee
Privacy Officer, oversee privacy/security program; developed and implemented a system for staff to report potential violations;
Liaison between regulatory agencies and internal departments to facilitate regulatory and related matters, including regulatory audits.
Conduct risk assessments to identify areas of noncompliance or vulnerability.
Create and manage action plans to mitigate audit discoveries and compliance concerns.
Maintain compliance frameworks, policies and documentation to support audits.
Advise management on best practices for regulatory requirements and compliance-related matters related to business operations.
Improved CMS Program Audit score by 50% in first year, and over 50% in second year
Implemented Compliance Management Solution to improve efficiency and drive results which eliminated the need to hire an additional staff member, thereby saving the organization $50,000 annually
Compliance Manager
Anthem, Inc.
Seattle, WA
02.2020 - 05.2021
Member of the Regulator Audit Center of Expertise, with expertise in Medicare, Medicaid, and Dual Eligible -Special Needs Plans.
Managed multiple ongoing projects simultaneously, coordinating multiple teams of internal and external stakeholders and regulatory agencies.
Reviewed supporting documents during regulatory audits to ensure accurate and timely submission.
Tracked progress towards meeting organizational objectives related to compliance.
Contributed to large-scale risk assessment initiatives and promoted improved business procedures and controls.
Provided training and guidance on regulatory requirements, industry standards, and best practices.
First Leader to achieve 100% score on a state government led D-SNP Audit Readiness Review.
Compliance Manager
Community Health Plan of Washington
Seattle, WA
08.2016 - 01.2020
Managed day-to-day operations relating to the organization's overall compliance function.
Developed and implemented a comprehensive compliance program to ensure adherence with applicable laws and regulations.
Implemented a comprehensive HIPAA privacy/security program, overseeing investigations of potential violations, managing the notification and reporting processes, and driving continuous improvement efforts.
Conducted internal audits, investigations and risk assessments to identify areas of non-compliance and recommend corrective actions.
Analyzed internal compliance processes to assure optimal efficiency and effectiveness.
Monitored changes in relevant legislation and regulatory guidance to ensure ongoing compliance with legal requirements.
Coordinated with external auditors regarding audit plans, findings, issues, and recommendations.
Developed and implemented an organization-wide Continuous Process Improvement training that aligned with annual business goals and objectives, resulting in increased efficiency and effectiveness in operations.
Medicaid/Medicare Subject Matter Expert
Strategic Health Solutions, LLC
Omaha, NE
08.2012 - 07.2016
Key member of Policy and Research Division for a Centers for Medicare & Medicaid Services (CMS) contractor
Conducted in-depth research and analysis of Medicaid, Medicare, and other health care laws, including proposed, modified, or new legislation, laws, regulations, and policies.
Developed health care law into plain language educational materials.
Drafted technical documents, such as fact sheets, booklets, and training materials, to ensure accuracy of content.
Mentored junior staff members on best practices related to product design and implementation strategies.
Researched and reviewed emerging laws and trends in order to develop innovative solutions that addressed business needs.
Developed content for organization's social media platforms, as member of Subject Matter Expert and marketing partnership.
Assessed company operations for compliance with regulatory and contractual requirements, as member of company Internal Audit Team.
Improved collaboration and cross-functional communication through the implementation of new technologies and processes by 25%, as member of company Innovation Team.
Supervisor/Manager
State of Iowa Department of Health and Human Services
Council Bluffs, IA
07.2005 - 08.2012
Supervised and evaluated the work of staff; recommended personnel actions, grievance resolution, work schedules, and assignments.
Minimized staff turnover through appropriate selection, orientation and training.
Coordinated and conducted quality control efforts as mandated for the federal government and ensured all reporting deadlines were met to avoid federal sanctions.
Leveraged leadership skills to identify deficiencies and opportunities to improve policies, procedures and controls.
Prepared formal responses to constituent complaints to ensure external stakeholders received a satisfactory outcome
Spearheaded an organizational change project to centralize and restructure the Medicaid long-term care medical institution unit for Iowa after budget cuts mandated a reduction in force from 44 to 22 staff.
Streamlined work process, eliminated waste, and improved timeliness and accuracy by having a LEAN/Kaizen event for each operational area.
Planned and delivered training sessions to external stakeholders to communicate the new structure, clarify requirements, which resulted in a decrease of complaints by approximately 50%.
Eligibility/Family Independence Specialist
State of Michigan Department of Health and Human Services
Grand Rapids, MI
02.1999 - 06.2003
Determined eligibility for Medicaid, cash, daycare, food assistance and emergency programs, assess needs and goals.
Balanced competing priorities through deliberate project and time management practices.
Monitored client progress and identified barriers to self-sufficiency during reviews.
Coordinated with hospital social workers, case managers, and patient accounts to assist patients applying for Medicaid and State Disability.
Prepared appeal summaries, exhibits, correspondence to parties, represented the department in administrative appeals process.
Education
Master of Public Administration -
Bellevue University
Bellevue, NE
Post Baccalaureate Certificate, Paralegal Studies -
Advanced Registered Nurse Practitioner at International Community Health Centers Shoreline Medical and Dental ClinicAdvanced Registered Nurse Practitioner at International Community Health Centers Shoreline Medical and Dental Clinic