David Jordan
McDonough,GA
Summary
Adept Compliance & Audit Specialist with a proven track record at MediGold, I excel in internal auditing, ensuring regulatory adherence, and fostering cross-functional teamwork. My expertise in compliance, coupled with exceptional communication skills, has significantly enhanced operational efficiencies. Renowned for reliability and professionalism, I consistently achieve organizational compliance goals, leveraging both hard and soft skills to navigate complex regulatory landscapes.
Overview
25
25
years of professional experience
Work History
Compliance & Audit Specialist
MediGold
Columbus, OH
09.2007 - Current
- Reviewed Operational Areas' existing policies, procedures, and processes for compliance with applicable regulations.
- Developed recommendations for improvements in internal systems and operational efficiencies.
- Coordinate with other departments to ensure proper reporting of any incidents that may have an impact on the company's compliance status.
- Assisted with the development of training materials for new staff members on Medicare compliance procedures.
- Review and evaluate applications to determine eligibility for Medicaid, Medicare, and other public assistance programs as part of departmental audits.
- Reviewed and monitored compliance with applicable laws, regulations, and policies to ensure compliance with regulatory requirements.
- Analyzed potential areas of risk and assisted with developing strategies to mitigate such risks.
- Conduct research on laws, regulations, and industry trends related to the organization's operations.
- Coordinate with internal stakeholders to ensure adherence to relevant rules and regulations.
- Investigate any suspected violations of the organization's compliance policies.
- Draft reports outlining findings from investigations into non-compliance incidents.
- As part of the HPMS Memo review and distribution process, I monitor changes in legislation that could affect the organization's operations.
- As part of the Annual Part C and Part D Data submission, prepared documents for submission to regulatory agencies, as required by law.
- Performed periodic reviews of existing processes and procedures to identify areas of improvement in terms of compliance standards.
- Participated in meetings with external auditors regarding audit results related to compliance matters.
- Maintain an up-to-date knowledge base of all relevant laws, regulations, guidelines, and industry standards.
- Collaborated with various departments within the organization to develop effective solutions for ensuring ongoing compliance.
- Implemented corrective action plans when necessary following discovery of non-compliance issues.
- Identify opportunities for process improvements that would increase efficiency while maintaining compliance standards.
- Assist senior management in developing strategies for addressing complex legal or regulatory issues.
- Track progress towards meeting established goals related to organizational compliance objectives.
- Pursue continuous learning opportunities regarding the latest compliance and procedural changes.
- Provided detailed, understandable risk and compliance concepts to key stakeholders.
- Create plans to improve and correct operations in order to stay compliant as part of developing Corrective Action Plans.
- Completed in-depth reviews of audit reports, client actions and monitoring activities.
- Reviewed company policies against best practices to better understand level of compliance.
- Established and maintained relationships with regulatory bodies and external compliance advisors.
- Conduct due diligence on third-party vendors with the Compliance Team to ensure compliance with company standards.
- Assisted in the development of compliance training materials and online resources.
- Collaborate with legal and operational teams to address compliance issues and implement corrective actions.
- Ensured effective communication of compliance policies and procedures throughout the organization.
- Monitor changes in legislation affecting the organization's operations by reviewing CMS guidance and Manual chapters, and update compliance frameworks, such as audit protocols, accordingly.
- Managed the preparation and submission of regulatory filings and reports.
- Performed regular compliance audits and presented findings to management.
- Developed and maintained comprehensive documentation of compliance procedures and policies.
- Conducted detailed audits of internal systems and processes to ensure compliance with regulatory standards.
- Coordinate with the Compliance Team for internal compliance review and monitoring activities to ensure adherence to laws and regulations.
- Monitor and report on compliance metrics and performance indicators for assigned Operational Areas.
- Analyze data to identify potential areas of compliance risk and recommend improvements.
- Follow proper protocols for reporting suspected violations to internal personnel or outside governing agencies.
- Collect and review data to identify potential compliance issues requiring further review.
- Maintain a detailed database of compliance data, activities, and actions taken.
- Support internal and external auditing teams conducting impartial compliance reviews.
- Enforce regulatory policies and procedures across different teams and programs.
- Confer frequently with specialists to stay current on compliance requirements and procedures.
- Evaluated applications and associated documentation to determine eligibility.
- Receive inquiries and advise on regulations related to programs.
- Produced reports outlining assessments completed and follow-up recommendations.
Benefits Analyst
Cigna
Columbus, OH
09.1999 - 03.2007
- Monitored changes in legislation that may affect existing or proposed health benefit plans.
- Tested various scenarios to ensure accuracy of data entry into the system.
- Established communication protocols with customers related to implementation timeline expectations.
- Performed quality assurance checks throughout the implementation process to verify accuracy of benefit coding.
- Served as liaison between customer support team and implementation team members in order to resolve any issues or questions that arose during implementation.
- Maintained detailed records of all changes made during the implementation process.
- Analyzed current business processes and identified areas where improvements could be made through automation.
- Implemented customizations according to customer specifications while adhering to established coding and configuration standards.
- Monitored progress of implementations in order to meet deadlines set by clients.
- Assisted in resolving escalated customer issues related to Benefits implementations.
- Configured software settings to meet customer needs based on functional specifications.
- Conducted post-implementation reviews to evaluate performance against expectations and make recommendations for improvement.
- Assisted in developing detailed project plans that included tasks lists, milestones, resources needed and estimated completion dates.
- Resolved issues related to application configuration or setup during testing phase by troubleshooting problems as they arose.
- Managed multiple concurrent projects while adhering to strict deadlines.
- Communicated regularly with clients regarding status updates on implementations projects.
Education
Bachelor of Arts - Music Concentration
University of Rochester
Rochester, NY05-1989
Skills
- Cross-Functional Teamwork
- Internal Auditing and Monitoring
- Compliance knowledge
- Reliability
- Communication Skills
- Professionalism
- Teamwork and Collaboration
Timeline
Compliance & Audit Specialist
MediGold
09.2007 - Current
Benefits Analyst
Cigna
09.1999 - 03.2007
Bachelor of Arts - Music Concentration
University of Rochester
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