Karla Hawkes, MHA, CHC, CCEP
Philadelphia,PA
Summary
Well-qualified certified compliance management professional skilled in evaluating, improving, and developing controls and monitoring systems. Enforce rules consistently, keeping the organization fully compliant with applicable regulations and standards. Offer strengths in monitoring, assessing, and reporting on compliance concerns.
Overview
10
10
years of professional experience
1
1
Certification
Work History
Corporate Compliance Operations Manager
AmeriHealth Caritas
12.2017 - Current
- Recruited talented compliance analysts to improve departmental skills and bolster organizational expertise
- Managed a team of associates and monitored deadlines to keep projects timely
- Trained employees in compliance-related topics such as reporting processes and important policies preventing many issues
- Conduct investigations into reported and identified compliance issues to determine relevance and obtain detailed information
- Identified vulnerabilities and areas of non-compliance and immediately implemented changes to promote improvement
- Documented compliance activities in full, including complaints received, investigations conducted, and outcomes achieved
- Complete both scheduled and surprise audits to verify compliance with established procedures
- Project manage regulatory audits through completion
- Prepared weekly and monthly reports regarding the results of inspections and compliance reviews
- Review reports to determine compliance status within individual departments
- Identified and reported compliance violations to board committees quarterly
- Prepared executive reporting to display sanctions, fin and corrective action information
- Initiate and support corrective action plans identified through audits, performance metrics, and monitoring
Senior Corporate Compliance Operations Analyst
AmeriHealth Caritas
08.2020 - 02.2022
- Support oversight of Medicaid and Medicare plans across multiple states by implementing compliance policies and monitoring activities
- Developed and implemented controls policies to mitigate risks while enhancing compliance with regulatory agencies
- Developed and implemented improved system controls, preventing the reoccurrence of compliance issues
- Compiled data from internal sources to identify areas of weakness requiring immediate compliance remediation
- Reviewed corporate policies and initiated new processes to improve objectives
- Organized and led compliance meetings with management staff and stakeholders to discuss emerging risks
- Created performance dashboards to present during monthly plan operational meetings
- Coached new team members of general audit process, technology, and department operations
Corporate Compliance Operations Analyst
AmeriHealth Caritas
12.2017 - 08.2020
- Identified compliance issues by statements, company records, and employee activities
- Completed detailed reports showing evidence of compliance issues and recommending and issuing corrective actions
- Investigated suspected compliance violations and assessed the validity of submitted claims
- Issued and monitored corrective action plans based on contractual guidelines and regulatory metrics
- Audited records, procedures, and controls to verify compliance with established policies and SOPs
Compliance Operations Analyst
McBee Associates
10.2016 - 10.2017
- Planned and coordinated operational activities to ensure compliance with governmental regulations and ordinances
- Performed internal audit reviews on company policies and procedures to ensure ongoing compliance
- Identified compliance issues and developed risk management strategies to avoid issues of non-compliance
- Researched regulations to ensure the firm is current with healthcare changes
- Served on the compliance committee to address issues and/or opportunities within the firm
- Developed compliance policies and procedures and reports for committee meetings
Jr. Auditor
Cotiviti
01.2015 - 08.2016
- Supported compliance with regulatory and quality standards through well-executed claim audits
- Investigated provider claims of varying complexity and obtained relevant facts to determine overpayments
- Calculated claims amounts following policy data and coverage requirements
- Exceeded a daily goal of identifying over $5,000 in overpayments per hour
Education
M.S. - Health Administration
St. Joseph’s University
Philadelphia, PA01.2014
B.A. - Business Administration
Strayer University
Springfield, PA01.2010
Skills
- Training and education
- Data gathering & reporting
- Project management
- Compliance applications (GRC Archer)
- Compliance initiatives
- Procedure auditing
- Root cause analysis
- Risk assessments
- Internal investigation management
- Excellent communication
- Privacy and Risk Management
Certification
- Certified Compliance and Ethics Professional, 2024, Society of Corporate Compliance and Ethics (SCCE) - EXP 10/2026
- Certified Healthcare Compliance, 2024, Health Care Compliance Association (HCCA) - EXP 10/2026
Jobtraining
GRC (Archer) Administrator & Lead Trainer, 01/2019, Present, Advanced in data tools, Corrective Action & Inquiry Management Applications, Fines/Sanctions/Penalties Application, Regulatory Intelligence Application, Targeted Review Application
Timeline
Senior Corporate Compliance Operations Analyst
AmeriHealth Caritas
08.2020 - 02.2022
Corporate Compliance Operations Manager
AmeriHealth Caritas
12.2017 - Current
Corporate Compliance Operations Analyst
AmeriHealth Caritas
12.2017 - 08.2020
Compliance Operations Analyst
McBee Associates
10.2016 - 10.2017
Jr. Auditor
Cotiviti
01.2015 - 08.2016
B.A. - Business Administration
Strayer University
M.S. - Health Administration
St. Joseph’s University
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