Chara Hoover
Dickson,TN
Summary
Meticulous and knowledgeable Compliance Manager with a 14-year record of success in policy development, program management, risk mitigation and operational planning. Proficient in maintaining regulatory compliance and correcting systemic issues in collaboration with business managers. Team-focused, consistent and diplomatic with a focus on building strategic alliances and enhancing company standing.
Overview
22
22
years of professional experience
1
1
Certification
Work History
Risk and Compliance Manager
Sanitas Medical Center TN market
09.2021 - Current
- Develop and oversee the ongoing management of the Sanitas Medical Center compliance and quality program for the 9 Medical Centers in the TN market
- Perform investigations related to potential compliance violations, or compliance concerns, clinical risk management issues, Quality complaints
- PCMH accreditation oversight and compliance with standards
- Quality Improvement Metrics oversight
- Reporting to the Board of Directors
- External audit oversight
- Monitor applicable laws, regulations, federal and state regulatory requirements
- Ensure operations implements new laws, regulations, federal and state regulatory requirements
- Maintaining Collaborative Agreements between NP/PA and Supervising Medical Doctors.
- Collaborated with legal counsel to ensure that operational activities are compliant with regulatory requirements.
- Provided guidance on complex regulatory issues to senior management and other departments.
- Developed and implemented policies and procedures to ensure compliance with applicable laws, regulations, standards, and best practices.
- Advised management on best practices in compliance-related matters.
- Drafted reports summarizing findings from audit reviews and investigations.
- Provided support in responding to inquiries from government agencies.
- Responded promptly to complaints received from employees or customers.
- Analyzed data gathered from multiple sources for possible breaches of law or policy.
- Ensured timely completion of periodic reports required by regulators.
- Prepared training materials related to regulatory changes or new policies and procedures.
- Conducted risk assessments to identify areas of noncompliance or vulnerability.
- Maintained detailed records regarding all activities associated with compliance initiatives.
- Developed and implemented compliance policies and procedures.
- Assessed the effectiveness of existing processes and procedures related to compliance.
- Evaluated proposed changes in laws or regulations that may affect business operations.
- Identified gaps in existing controls and recommended corrective actions as needed.
- Investigated potential violations of applicable rules and regulations.
- Provided guidance on regulatory requirements for business operations.
- Worked successfully with diverse group of coworkers to accomplish goals and address issues related to our products and services.
- Collaborated with internal departments such as Human Resources, Finance, IT. to ensure compliance with relevant laws and regulations.
- Conducted periodic reviews of program operations to ensure compliance with accreditation requirements.
- Developed training materials to educate faculty and staff on the importance of accreditation standards.
Sr Compliance Manager- Care Delivery
Kaiser Permanente
07.2017 - 09.2021
- Develop and oversee the ongoing management of the Kaiser Permanente Colorado Market compliance program for care delivery -Health Plan and Medical Group
- Consult on Compliance Matters to Care Delivery Teams by providing relevant statutory, and regulatory guidelines specific to inquiries from care delivery departments
- Respond timely to questions or requests of an urgent nature from care delivery leadership and acts as an internal resource to care delivery and compliance leadership
- Research issues as necessary, assessing implication on operations and administrative processes
- Perform investigations related to potential compliance violations, or compliance concerns
- Function as the compliance partner to regional subject matter experts on national Care Delivery Community of Practice teams
- Consult with care delivery departments as they implement initiatives or alter current practices to assure compliance
- Collaborate with care delivery and compliance leadership to determine impact of proposed federal and state statutes and regulations on care delivery and medical group operations
- Provide feedback to Government Relations and coordinate communication and discovery activities of care delivery matters between Kaiser Permanente legal and outside counsel as required
- Develop and oversee the ongoing management of the Kaiser Permanente Colorado (KPCO) Regional compliance program for care delivery
- Monitor applicable laws, regulations, federal and state regulatory requirements
- Ensure operations implements new laws, regulations, federal and state regulatory requirements
- Maintain knowledge of policies and procedures and perform in accordance with the Principles of Responsibility and applicable regulatory requirements, external laws and when appropriate, accreditation standards
- Appropriately report observed fraud or abuse
- Maintains and supports a culture of compliance, ethics and integrity
- Support Revenue Cycle compliance, and serve as consultant for coding, billing, and health information systems issues/concerns
- Interim Civil Rights Coordinator for Kaiser Permanente Colorado Market area
- Coordinate responses to member concerns for Civil Rights violations, write responses to Office of Civil Rights for any formal complaints.
- Provided training and guidance on the organization's policies and procedures related to compliance activities.
- Drafted reports outlining audit results, trends, observations, conclusions, and recommendations.
- Monitored changes in relevant legislation and regulatory guidance to ensure ongoing compliance with legal requirements.
- Assisted in developing strategies to reduce potential risks associated with non-compliance activities.
- Collaborated with senior management teams to develop solutions for complex compliance issues.
Accreditation Specialist
Kaiser Permanente
Denver
02.2015 - 07.2017
- Performed as functional expert in field within KP of new governmental standards, requirements and regulatory environment to enable region to prepare strategies for future implementation
- Worked in collaboration with Medical Group, Regional departments and Program office to ensure high level of performance with regulatory, accreditation and internal requirements and surveys e.g
- NCQA, CMS, DOI, DPHE, QHIC and Board of Directors
- Key contact for the organization for NCQA and responsible for meeting all required timeframes and deliverables as it relates to NCQA
- Ensured that the training activities incorporate all applicable KP policies, local, state and federal laws and regulations, and accreditation standards
- Lead cross functional project teams.
PRN Registered Nurse
Maxim Healthcare
01.2012 - 01.2016
- Served as a resource person for staff members on assigned shift.
- Maintained accurate records of patient assessment data, treatments administered and changes in condition or response to treatment plans.
- Communicated effectively with physicians, nurses and other healthcare professionals to coordinate quality patient care.
- Contributed significantly toward meeting departmental goals related to customer service satisfaction scores.
- Collaborated with multidisciplinary teams from outside agencies when necessary for continuity of care across settings.
- Conducted rounds to assess the condition of critical care patients.
- Facilitated communication between family members during times of crisis or change in condition status.
- Educated families regarding end-of-life decisions, palliative care planning, and other medical procedures as needed.
- Demonstrated excellent problem solving skills while managing multiple tasks simultaneously under stressful conditions.
Compliance Auditor
Kaiser Permanente
Denver
04.2013 - 02.2015
- Conducted retrospective audits of documentation supporting E&M, CPT and ICD9 codes
- Planned and performed comprehensive chart audits to identify operational and regulatory issues related to coding, documentation, and compliance requirements
- Ensured complete and accurate data capture in compliance with Federal and State requirements
- Provided technical expertise to Regional and local leadership to identify and resolve coding and chart documentation problems impacting the accuracy and consistency of coded data
- Entered audit results into National Compliance Office audit tools to support quality assurance process, analysis and training activities
- Conducted quality assurance reviews
- Identified audit trends and risk areas based on audit findings and data analysis
- Assisted in developing and implementing policies and procedures / Compliance Audit Standards to ensure compliance with Federal, State and other regulatory requirements.
- Developed audit plans for evaluating compliance with regulatory requirements.
Auditor IV
NATIONAL Compliance
Oakland, CA
04.2011 - 04.2013
- Conducted retrospective audits of documentation supporting E&M, CPT and ICD9 codes
- Planned and performed comprehensive chart audits to identify operational and regulatory issues related to coding, documentation, and compliance requirements
- Ensured complete and accurate data capture in compliance with Federal and State requirements
- Provided technical expertise to Regional and local leadership to identify and resolve coding and chart documentation problems impacting the accuracy and consistency of coded data
- Entered audit results into National Compliance Office audit tools to support quality assurance process, analysis and training activities
- Identified audit trends and risk areas based on audit findings and data analysis
- Reviewed analytical data and audit findings to identify coding trends and other risk areas and recommends appropriate action
- Mentored and led a group of Clinical and Coding staff.
Registered Nurse
Memorial Medical Center
Modesto, CA
01.2007 - 01.2012
- Conducted patient assessments and developed care plans
- Collaborated with Charge RN and care team to implement and evaluate care plan effectiveness
- Assisted patients with daily activities (lifting, turning, mobilizing)
- Monitored vital signs; maintained current documentation
- Identified psychological/social conditions to determine travel viability within community
- Assisted patient/family members to manage medical equipment outside of home.
Clinical Documentation Consultant Team Lead
Regional Offices
10.2009 - 04.2011
- Utilized clinical knowledge & knowledge of coded data for documentation requirements to improve overall pant quality, capture severity, acuity & risk of mortality
- Established effective working relationships with the local and regional staff/teams/leadership
- Facilitated appropriate clinical documentation to support diagnosis capture and to ensure the level of service rendered to all patients is recorded
- Maintained records of productivity and monitored accuracy of Clinical Documentation Consultants
- Analyzed and reported productivity and quality assurance data to leadership
- Developed tools for staff education in-services
- Performed quality assurance analysis of staff member’s work.
Clinical Documentation Consultant
Regional Offices
08.2008 - 10.2009
- Utilized clinical knowledge & knowledge of coded data for documentation requirements to improve overall patient quality, capture severity, acuity & risk of mortality
- Established effective working relationships with the local and regional staff/teams/leadership
- Facilitated appropriate clinical documentation to support diagnosis capture and to ensure the level of service rendered to all patients is recorded
- Partnered with representatives in the Business Intelligence Team to develop a web-based tool for the use for the Clinical Review Team
- Tool was successfully implemented 1/1/2010.
Continuing Care Coordinator RN
Central Valley HUB
01.2007 - 01.2008
- Conducted clinical reviews in collaboration with MDs based on established treatment criteria (vital signs, lab values, pertinent clinical data)
- Assisted external/internal health care providers in discharge planning process to triage to alternative care units
- Investigated and reported unusual occurrences to Continuing Care Administrator
- Coordinated referrals to appropriate agencies/facilities
- Partnered with Staff Assistants to create Workplace Safety collateral to build employee awareness on safety goals in Central Valley.
Travel Nurse
01.2004 - 01.2007
Home Health Nurse
Bayada Home Health
01.2003 - 01.2004
Registered Nurse
Wake Forest University Baptist Medical Center
01.2002 - 01.2004
- Assisted patient/family members to manage medical equipment outside of home.
- Utilized evidence-based practice guidelines when making clinical decisions related to patient care.
- Participated in multidisciplinary rounds involving physicians, nurses, social workers and other healthcare professionals.
- Assumed charge nurse responsibilities when needed, including delegating tasks to other staff members.
- Monitored vital signs including pulse oximetry, blood pressure, temperature and respiration rate.
- Provided emotional support for families dealing with difficult diagnoses or life-threatening illnesses.
- Evaluated laboratory results to determine patient response to therapy or medication changes.
- Assisted physicians with procedures such as intubation, chest tube insertion and central line placement.
Education
Masters of Business Administration - Healthcare Management
American Intercontinental University
01.2010
Bachelors of Business Administration - Healthcare Management
American Intercontinental University
01.2009
Associates in Applied Science - Nursing -
Northern Virginia Community College
01.2002
Skills
- Document analysis
- Quality controls
- Conducting investigations
- Document reviews
- Information Gathering
- Audit oversight
- Audits management
- Regulatory Documentation
- Investigative skills
- Incident Response
- Analytical Thinking
- Process Development
- Regulatory Standards
- Corporate Governance
- Policy analysis
- Training delivery
- Teamwork and Collaboration
- Effective Communication
- Audit Support
Certification
- Registered Nurse, LISC#205392, Colorado Division of Professions & Occupations, 2012 - Present
- Registered Nurse, LISC #690707, California Nurses Association, 2006 – 2010
- Registered Nurse, LISC #183888, North Carolina Nurses Association, 2002 – 2013
- Certified Clinical Documentation Specialist, 2012
- Certified Professional Coder, CERT # 01153304, 2010
- Certified Healthcare Compliance, 2021
Affiliations
- TN achieves mentor
- Volunteer in Kids program for Crosspoint-Dickson
Timeline
Risk and Compliance Manager
Sanitas Medical Center TN market
09.2021 - Current
Sr Compliance Manager- Care Delivery
Kaiser Permanente
07.2017 - 09.2021
Accreditation Specialist
Kaiser Permanente
02.2015 - 07.2017
Compliance Auditor
Kaiser Permanente
04.2013 - 02.2015
PRN Registered Nurse
Maxim Healthcare
01.2012 - 01.2016
Auditor IV
NATIONAL Compliance
04.2011 - 04.2013
Clinical Documentation Consultant Team Lead
Regional Offices
10.2009 - 04.2011
Clinical Documentation Consultant
Regional Offices
08.2008 - 10.2009
Registered Nurse
Memorial Medical Center
01.2007 - 01.2012
Continuing Care Coordinator RN
Central Valley HUB
01.2007 - 01.2008
Travel Nurse
01.2004 - 01.2007
Home Health Nurse
Bayada Home Health
01.2003 - 01.2004
Registered Nurse
Wake Forest University Baptist Medical Center
01.2002 - 01.2004
Masters of Business Administration - Healthcare Management
American Intercontinental University
Bachelors of Business Administration - Healthcare Management
American Intercontinental University
Associates in Applied Science - Nursing -
Northern Virginia Community College
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