Kerri Spalliero
Littlerock,Ca
Summary
Compliance professional prepared to bring in-depth auditing expertise to ensure adherence to regulations and policies. Known for identifying and addressing compliance issues while fostering team collaboration and driving results. Skilled in risk management and regulatory reporting, with reliable and adaptable approach.
Overview
18
18
years of professional experience
Work History
Compliance Auditor
MedPOINT Management
06.2018 - Current
- Conduct thorough regulatory reporting and compliance audits to ensure adherence to industry standards and legal requirements
- Utilize advanced data analysis techniques to identify trends and anomalies, ensuring accuracy and completeness of financial and operational data
- Lead comprehensive audits of internal processes, systems, and controls, identifying areas for improvement and recommending proactive measures to mitigate risks
- Collaborate with cross-functional teams to implement process improvements, resulting in increased efficiency and effectiveness in compliance procedures
- Produce detailed audit reports, outlining findings and recommendations for management review and action
- Stay abreast of regulatory changes and industry best practices, proactively updating audit procedures to maintain compliance with evolving standards
- Participate in compliance training programs, educating employees on the importance of adherence to regulations and internal policies
- Conduct periodic follow-up reviews to track the implementation of audit recommendations and measure the effectiveness of process enhancements
- Act as a subject matter expert, providing guidance and support to team members on complex compliance-related matters
- Foster a culture of compliance and ethics within the organization, promoting a proactive approach to regulatory adherence and risk management
Compliance Specialist
Heritage Provider Network - HDMG
01.2014 - 05.2018
- I was responsible for all health plan compliance-related functions including monthly and quarterly reporting, scheduling and coordinating all health plan audits
- Running and preparing required audit universe reports
- Pre-auditing all audit selections, being available to the auditor during the audit
- Prepare and enact any corrective action plans that may result from the audit findings
- In addition to compliance, I also managed the day to day workload of the nine claims processors and the data analyst
Data Analyst Lead
Heritage Provider Network - HDMG
11.2008 - 12.2013
- I was responsible for the daily electronic file in loads, including claim encounter files, professional claims files, and facility claim files
- I would retrieve files from FTPs for vendors such as Office Ally, Emdeon, and others
- I would then edit files to correct any rejected claims and post records
- Along with the daily claims in loads I also regularly extracted and analyzed claim data for any project needed such as modifier review, copay review, and audit finding impact review
Claims Processor II
Heritage Provider Network - HDMG
11.2006 - 11.2008
- I processed professional claims for all lines of business for both contracted as well as non contracted providers
- I worked a daily production quota of 150 claims a day
Education
Certified Medical Assistant - Phlebotomy, EKG Tech
Career Care Institute
Lancaster, Ca01.2002
High School -
Lancaster High School
Lancaster, Ca05.1999
Skills
- Dedicated administration professional with experience handling a wide range of administrative, technical and executive tasks
- More than 22 years of experience working in a claims office
- Extensive experience and understanding of electronic file processing, including EPF and 837p/837h files
- Focused on compliance working with health plan auditors
- Extensive understanding of CMS and DMHC regulations and standards
- Proficient in Microsoft Office Suite (Word, Excel, Outlook, PowerPoint)
- Excellent customer service skills
- Motivated self-starter who enjoys challenges
- Analytical thinker with strong problem-solving skills
- Proven track record of accurately maintaining detailed records, generating reports, coordinating meetings, and multitasking
- Strong computer skills
- Auditing experience
Timeline
Compliance Auditor
MedPOINT Management
06.2018 - Current
Compliance Specialist
Heritage Provider Network - HDMG
01.2014 - 05.2018
Data Analyst Lead
Heritage Provider Network - HDMG
11.2008 - 12.2013
Claims Processor II
Heritage Provider Network - HDMG
11.2006 - 11.2008
High School -
Lancaster High School
Certified Medical Assistant - Phlebotomy, EKG Tech
Career Care Institute
Similar Profiles
Erick MartinezErick Martinez
Member Service Representative at MEDPOINT MANAGEMENTMember Service Representative at MEDPOINT MANAGEMENT
Sarah StevensSarah Stevens
Provider Of Network Operations at MedPoint ManagementProvider Of Network Operations at MedPoint Management
Emil AmirianEmil Amirian
HIT, Senior Business Analyst at MedPOINT ManagementHIT, Senior Business Analyst at MedPOINT Management