Fra Buchanan
Regulatory Compliance Analyst
Virginia Bch,Virginia
Summary
Experienced Compliance Analyst with over15 years of experience in the Medicaid Industry. Excellent reputation for resolving problems and improving customer satisfaction. Seeking a full-time position that offers professional challenges utilizing interpersonal skills, excellent time management and problem-solving skills. Fantastic critical thinker that efficiently organizes vast amounts of data. Great at performing internal audits, conducting investigative reporting and interpreting state contracts.
Overview
16
16
years of professional experience
6
6
years of post-secondary education
Work History
Regulatory Compliance Analyst
ANTHEM Health Services
Virginia Beach, VA
02.2018 - Current
- Report, communicate, research laws at the advanced level, regulations, requirements, regulatory audits.
- Provide support to regulatory audits, internal audits, accreditations, risk assessments.
- Analyze and extract regulatory data, documentation for compliance with regard to contract requirements.
- Compliance monitor to identify process gaps, validate compliance levels, map processes, draft remediation plans.
- Conduct investigations, document findings, update stakeholders and leadership on developments, comply with notification requirements, ensure corrective actions are made.
- Assign, track and analyze member complaints directly from state partners.
Compliance Analyst
ANTHEM Health Services
Virginia Beach, VA
01.2013 - 02.2018
- Stayed current with latest changes to applicable regulatory standards and company procedures.
- Reviewed audit and monitoring reports related to consumer and client activities.
- Assisted investigation and risk management teams with fraud investigations and risk identification.
- Supported and trained associates on compliance-related issues.
- Prepared documentation and records for upcoming audits and inspections.
- Helped create training programs to handle system-wide issues and maintain compliance.
- Updated excel spreadsheets with latest data to enhance strategic planning.
- Enforced compliance with complex state and federal laws, rules and regulations for industry.
- Reviewed and interpreted state contract documents.
- Applied knowledge of state and federal laws to complete more than 900 accurate and thorough compliance collaterals annually.
Privacy Consultant
Anthem (Amerigroup)
Virginia Beach, VA
08.2006 - 09.2013
- Stayed current with latest changes to applicable privacy/HIPAA standards and company procedures.
- Reviewed audit and monitoring reports related to member privacy.
- Assisted investigation and risk management teams with privacy breaches.
- Supported and trained associates on compliance-related issues.
- Confirmed data and licensing information through investigations and notified violators of required changes to bring operations into compliance.
- Reviewed federal/state laws and updated investigation strategies to reflect current information.
- Applied knowledge of federal laws to complete more than 200 accurate and thorough compliance investigations.
- Took notes on field examinations and specific case details, updated databases and produced reports outlining results of investigations.
- Performed scheduled and unannounced investigations of workplaces for company wide privacy procedures.
- Prepared documentation and records for upcoming audits and privacy inspections.
- Reviewed and interpreted contract documents to write/update privacy policies for the company.
Education
Bachelor of Science - Health Administration
Saint Leo University
Saint Leo, FL 08.1997 - 12.2000
MBA - Healthcare Management
University of Phoenix
Tempe, AZ 08.2004 - 12.2006
Skills
Auditing experience
Interpreting state regulations
Excellent Communication
Organization and Time Management
Timeline
Regulatory Compliance Analyst
ANTHEM Health Services
02.2018 - Current
Compliance Analyst
ANTHEM Health Services
01.2013 - 02.2018
Privacy Consultant
Anthem (Amerigroup)
08.2006 - 09.2013
MBA - Healthcare Management
University of Phoenix
08.2004 - 12.2006
Bachelor of Science - Health Administration
Saint Leo University
08.1997 - 12.2000