Summary
HEALTHCARE COMPLIANCE, REGULATORY, AND QUALITY EXECUTIVE Strong leader in healthcare management and compliance with progressive and extensive experience in driving operational, productivity and service goals across diverse environments. Demonstrable talent for identifying and resolving issues, developing process improvement plans, and teaching and executing best practices to streamline workflow. Tenacious driver of improved clinical and financial outcomes. Expertise in human resource management through empowering others, providing motivational support, establishing focus and cultivating talent. Highly skilled in analytical thinking, training, implementing and managing change.
Overview
23
23
years of professional experience
1
1
Certification
Work History
Director of Health Care Compliance and Privacy
Avalon Health Care
04.2020 - Current
- Coordinate/Investigate Complaints/Concerns reported to the Compliance Department
- Developed and updated policies and procedures, maintaining compliance with guidelines relating to HIPAA and Health Care Compliance
- Developed, trained, and maintained a Health Information Management (HIM) Manual, which included policies, procedures, and guidelines for medical records maintenance and Records Management
- Assist other departments with development of Policies and Procedures
- Provide guidance and support to all Avalon businesses in developing, implementing, and maintaining effective compliance programs
- Directs resources to develop, establish, and maintain corporate compliance programs, policies, procedures, and controls to ensure that all operations conform to established standards, agency regulations, guidelines, and industry compliance trends
- Designs tracking mechanisms and tools and monitors processes and policies related to regulatory compliance
- Responds to all complaints/concerns; Respond to requests from Government Agencies;
- Manage company Policy Center.
- Agency for Health Care Administration (ACHA) Silver Quality Award Examiner
Senior Director, Policy Management and Training
Golden Living, Formerly Beverly Enterprises
01.2013 - 05.2021
- Lead daily functions, implementation of quality assurance, policy management, training, regulatory compliance, and prevention of civil money penalties in facility
- Instituted formal operating procedures and enforced adherence to policies and regulations that impacted bottom-line.
- Drove strategic improvements to enhance operational and organizational efficiencies.
- Led development of business operation processes and policies.
- Execute protocols, development, training, and review/coordinate/response to the customer response and compliance hotline
- Direct the development, protocol and execution of quality assurance, policy management and training nationwide.
- Prioritized and allocated valuable resources to meet business targets.
Director, Health Information Management
Golden Living, Formerly Beverly Enterprises
01.2009 - 01.2013
- Developed Manual, trained, and consulted to 302 facilities nationwide to ensure compliance of medical records and systems
- Conducted compliance and quality visits to facilities to assess facility-level care and compliance system effectiveness
- Reviewed and responded to HIM reports monthly and advised senior leadership of current risks
- Conducted HIM audits to assist with education related to health information.
- Upheld HIPAA regulations and standards for protecting patient information.
- Performed regular quality and validation assessments on patient data to verify accuracy.
- Established departmental performance goals and provided feedback for underperforming areas.
- Oversaw operations and provided corrective feedback to achieve daily and long-term goals.
- Evaluated company documentation to verify alignment with regulatory requirements.
Transition Director/ Customer Relations Liaison
Golden Living, Formerly Beverly Enterprises
01.2001 - 01.2009
- Represented the company's interests in 15 states with sold facilities by ensuring the company maintained proactive presence in the state
- Continually maintained and improved company's reputation and positive image in markets served.
- Served as company liaison between external and internal parties to effectively manage and resolve issues
- Partnered with legal representatives, regional counsel, and other associates to reconcile sold receivables, coordinate timely and proper authorized release of medical records, facilitated investigations of potential liability claims, investigated and documented findings of complaints/concerns, and other issues
- Managed facility divestitures by coordinating with state regulatory agencies and vendors regarding medical record scanning, storage, and completion of disposition assessments
- Conducted audits for Centers for Medicare and Medicaid Services (CMS) and Office of Inspector General (OIG) to ensure corporate Medicare compliance
- Toured facilities to identify concerns related to medical records and to provide education and training.
Education
M.S - Public Administration, Health Care
M.S - Therapeutic Recreation
B.S - Exercise Science
Skills
- Regulatory Compliance
- Policy Management
- HIPAA
- Quality Management
- Program Development
- Project Management
- Strategic Planning
- Root Cause Analysis
- Risk Management
- Complaint Resolution
- Electronic Health Records
- Planning and Coordination
- Excellent Communication
- Self-Motivated
- Teamwork and Collaboration
- Critical Thinking
- Problem-Solving
- MS Office
- Decision-Making
- Training and Development
- Active Listening
- Flexible and Adaptable
- Attention to Detail
- Organization and Time Management
Websites
Certification
Certified Professional Compliance Officer, AAPC
Certified Risk Manager, Florida Risk Management Institute
QAPI Certified Professional, AAPACN
Certified Agile Program Management Fundamentals, MSIcertified
Timeline
Director of Health Care Compliance and Privacy - Avalon Health Care
04.2020 - Current
Senior Director, Policy Management and Training - Golden Living, Formerly Beverly Enterprises
01.2013 - 05.2021
Director, Health Information Management - Golden Living, Formerly Beverly Enterprises
01.2009 - 01.2013
Transition Director/ Customer Relations Liaison - Golden Living, Formerly Beverly Enterprises
01.2001 - 01.2009
Grand Canyon University - M.S, Public Administration, Health Care
University of Florida - M.S, Therapeutic Recreation
University of Florida - B.S, Exercise Science
Similar Profiles
Jessika RamirezJessika Ramirez
Intern at Avalon Health CareIntern at Avalon Health Care
Pauline RamirezPauline Ramirez
Admissions Coordinator at Avalon Health CareAdmissions Coordinator at Avalon Health Care
Zali O'MalleyZali O'Malley
Assistnat in Nursing at Avalon Health careAssistnat in Nursing at Avalon Health care
Rosie ShresthaRosie Shrestha
Registered Nurse at Avalon Health CareRegistered Nurse at Avalon Health Care
PJ RossiPJ Rossi
Executive Director, HR Privacy, Compliance, Governance & EEO/AA Management at UNITED STATES AUTOMOBILE ASSOCIATION (USAA)Executive Director, HR Privacy, Compliance, Governance & EEO/AA Management at UNITED STATES AUTOMOBILE ASSOCIATION (USAA)