Marianna (Annie) Miyazaki-Grant

VP, Compliance & Regulatory Affairs, 03/2015 - 07/2018

Director, Compliance & Regulatory Affairs, 02/2013 - 03/2015

Built and led Compliance, Privacy, SIU, Risk Management, Internal Audit, and Insurance functions for a $3+ billion integrated Medicare and Medicaid health plan, and home and community-based provider in operation for over 130 years.

• Implement an AI-enabled strategic vision for enhancing a best-in-class program that enables business integrity and operational excellence.
• Provide risk-based, practical, and collaborative advice to the executive team and management.
• Maintain strong external regulator and partner relationships as Chief Compliance Officer.
• Regularly report to the Board and Audit Committee, and liaise with the external financial auditor.
• Direct enterprise risk management, insurance procurement, and claims management functions.
• Oversee an Internal Audit team that conducts financial and IT audits, as well as controls testing for the NYS Model Audit Rule.
• Indirectly supervise and regularly champion IT Security and AI Governance practices.

Key Achievements:

• Created a highly rated and scalable enterprise function.
• Spearheaded the development of the Compliance, Risk, and Legal Operations team to implement lean and agile processes.
• Led multi-million dollar annual SIU and payment integrity efforts.
• Unique operational experience, as evidenced by being regularly tapped to lead mission-critical projects in response to the COVID-19 pandemic.
• Responsible for external audit response, with a track record of success in mitigating audit risks of over $600 million.
• Ran effective government enforcement responses under Legal's direction for five major false claims investigations and related private litigations.
• Built parallel strategic, regulatory, and fraud risk assessment processes that are embedded in strategic and financial planning.

Summer Associate, 05/2006 - 08/2006

• Seconded from 2010-2011 to a national home health and healthcare staffing agency that was newly subject to a federal Corporate Integrity Agreement. Regularly met with senior leadership and managed a year-long corporate restructuring; updated policies and procedures and training materials to ensure consistency with obligations under CIA and business-driven operational changes; created and maintained a database of licensing and payor sources to support the in-house Legal & Compliance teams; managed a 50-state review of vaccine administration, corporate practice, companion care, and pharmacy licensure rules to address changes in the regulatory landscape and business strategy.
• Advised clients on state healthcare licensure, certificate of need, fraud and abuse, corporate compliance, vaccine administration, professional licensure, corporate practice, privacy and security, competitive bidding, and Medicare and Medicaid enrollment and reimbursement issues.
• Managed regulatory matters involved in complex healthcare transactions for national healthcare providers, including home health agencies, hospitals, and long term care facilities; drafted corporate documents and assisted in real estate, financing, and operations transfer closings.
• Counseled clients in responding to licensure and payor audits and surveys; represented clients in meetings with state and federal regulators.
• Assisted clients with drafting and implementing plans of correction; drafted policies and procedures, training materials, and job aids to address areas of non-compliance.