Summary
Overview
Work History
Education
Skills
Certification
Timeline
Generic

Kristin M Buettner

Deland

Summary

Dynamic senior compliance executive with over 20 years of progressive leadership experience in healthcare compliance and regulatory oversight focusing on developing and managing comprehensive compliance frameworks that align operational integrity with strategic objectives across Medicare Advantage, Prescription Drug Plans, and Accountable Care Organizations.

Overview

13
13
years of professional experience
1
1
Certification

Work History

Senior Director, Medicare Compliance

Centene
10.2024 - Current
  • Manage a team of 18 associates tasked with sales and marketing oversight ensuring up-to-date knowledge of industry regulations and best practices.
  • Provide regulatory guidance, support, interpretation, and oversight to Medicare Advantage and Medicare D-SNP business areas while championing ethical business practices minimizing adverse consequences to the organization.
  • Mitigate risk effectively by identifying potential threats, developing risk mitigation strategies, and implementing mitigation plans in line with regulatory requirements and business objectives.
  • Develop, implement, and maintain internal and external audits to confirm compliance with applicable laws and regulations and reduce legal risk.
  • Collaborate with executive leadership to identify potential compliance risks and develop mitigation strategies.
  • Promote a culture of continuous improvement through ongoing evaluation and refinement of compliance policies and their impact on operations.
  • Developed and maintain strong relationships with key federal and state regulatory agencies, such as the Centers for Medicare & Medicaid Services (CMS) and state Departments of Insurance (DOI), fostering collaboration and mutual strategic opportunities.
  • Evaluate new regulations for potential impact on business operations, taking proactive measures to ensure readiness for implementation and providing expert guidance on complex regulatory matters.
  • Spearhead investigations into potential violations, promptly addressing issues to maintain company reputation and avoid sanctions while reducing incident rates by implementing robust compliance monitoring and enforcement.
  • Design and conduct thorough risk assessment frameworks to evaluate organizational vulnerabilities, formulate mitigation strategies, and prioritize areas requiring attention.




ACO Compliance Officer

Centene
01.2020 - 10.2024
  • Enhanced regulatory compliance by developing, implementing, and auditing comprehensive policies, procedures, and business processes focused on the Office of Inspector General (OIG) Elements of an Effective Compliance Program.
  • Developed, implemented, and maintained comprehensive and engaging compliance training programs for internal staff and over 2,500 independent providers focused on compliance requirements, enhancing overall awareness and accountability.
  • Demonstrated adaptability in response to evolving industry standards, maintaining best-in-class practices in a dynamic regulatory environment.
  • Ensured timely identification of potential issues by establishing robust monitoring systems, risk assessments, corrective actions, and controls to reduce compliance vulnerabilities across departments, minimizing adverse consequences to the organization and mitigating legal risks.
  • Coordinated with external regulators to clarify compliance expectations, ensure company practices were fully aligned, and facilitate transparent communication. to ensure ethical business practices.
  • Championed ethical business practices, instilling a sense of corporate social responsibility across all departments while spearheading investigations into potential violations, promptly addressing issues to maintain company reputation and avoid sanctions.
  • Provided expert guidance on complex regulatory matters, enabling informed decision-making within the organization while promoting a culture of continuous improvement through ongoing evaluation and refinement of compliance program elements.
  • Evaluated new regulations for potential impact on business operations, taking proactive measures to ensure readiness for implementation while mitigating potential financial penalties.
  • Supported business expansion efforts by ensuring new initiatives were fully compliant with existing and emerging regulations.
  • Provided regular reporting, guidance, and feedback to the governing body/board of directors to over 25 Accountable Care Organizations (ACOs) on a regular basis while maintaining an open, ongoing, and transparent relationship.



Senior Director, Regulatory and ACO Compliance

WellCare
04.2017 - 01.2020
  • Directed strategic initiatives to enhance operational efficiency across multiple departments by leading cross-functional teams in developing innovative solutions to complex business practices.
  • Spearheaded organizational change initiatives that streamlined processes and enhanced productivity while ensuring compliance with regulatory requirements across multiple product lines such as ACOs, MA, PDP, provider-based facilities, and specialty lines such as correctional care and reinsurance.
  • Developed and maintained comprehensive regulatory documentation for submissions while communicating effectively with regulatory agencies regarding submissions, inquiries, and escalated issues.
  • Monitored changes in regulations and assessed their impact on products while providing training to staff on regulatory processes and best practices focused on critical aspects of industry regulation resulting in increased staff awareness and a strengthened culture of compliance.
  • Minimized risk of non-compliance penalties by leading regular internal audits and implementing corrective actions as needed to ensure compliance and efficiency.
  • Championed the adoption of new regulatory strategies by staying abreast of industry trends, attending relevant conferences, and participating in networking events with key stakeholders.
  • Facilitated smooth communication between departments by serving as the primary liaison between regulatory affairs and other functional areas within the organization including governance committees.
  • Drove continuous improvement in regulatory processes by identifying areas of inefficiency, proposing solutions, and implementing changes that led to measurable improvements in overall performance.


Assistant Vice President, Compliance

Universal American
04.2013 - 04.2017
  • Management of eleven staff members responsible for internal and external complaint/marketing misrepresentation investigations, quality assurance & marketing event surveillance, auditing, and corrective action plan enforcement and administration, marketing material approval, and regulatory agency filing while ensuring operational efficiency and compliance.
  • Experienced in regulatory and third-party audits including, but not limited to, federal sanction and remediation as well as Corporate Integrity Agreement (CIA) administration and resolution.
  • Provided oversight of organization-wide audit activities including universe pulls, sample preparation, compliance validation, employee preparedness, delivery of audit documentation, and communications with regulatory agencies.
  • Assisted in the implementation of "best practice" risk management sales oversight model to effectively monitor over 2,500 appointed sales agents to prevent, detect, and correct instances of non-compliance while protecting beneficiaries and member from marketing misrepresentation and fraud, waste and abuse (FWA). Program success evidenced by year over year reduction of marketing misrepresentation complaints received through the Health Plan Management System (HPMS) Complaint Tracking Module (CTM).
  • Interacted daily with corporate operational and business areas regarding compliance, sales oversight, licensing, agent credentialing, and commissions.
  • Reviewed, edited, approved, and filed as necessary all agent communications and training presentations to ensure regulatory requirements related to advertising, marketing, and content standards are met.
  • Developed training programs for junior staff, enhancing skill sets and promoting professional development within the team.
  • Collaborated closely with executive leadership to align department goals with overall company objectives, resulting in stronger organizational cohesion by attending regular meetings and special sessions contributing to major administrative initiatives, policies, and decisions.
  • Managed large-scale projects and introduced new systems, tools, and processes to achieve challenging objectives.
  • Cultivated and strengthened lasting client relationships using strong issue resolution and dynamic communication skills.

Education

Bachelor of Science - Marketing

University of Central Florida
Orlando, FL

Skills

  • Collaborative leadership
  • Regulations enforcement
  • Corporate governance
  • Investigations skills
  • Strategic planning
  • Federal and state regulations
  • Legal and regulatory compliance
  • Program management
  • Government relations
  • Compliance monitoring
  • Auditing processes
  • Ethics management

Certification

  • Lean Six Sigma Yellow Belt
  • Associate (ALMI) Life Office Management Association (LOMA)
  • Health Plan Management System (HPMS)
  • Accountable Care Organization Management System (ACO-MS)
  • Archer
  • Compliance360

Timeline

Senior Director, Medicare Compliance

Centene
10.2024 - Current

ACO Compliance Officer

Centene
01.2020 - 10.2024

Senior Director, Regulatory and ACO Compliance

WellCare
04.2017 - 01.2020

Assistant Vice President, Compliance

Universal American
04.2013 - 04.2017

Bachelor of Science - Marketing

University of Central Florida

Similar Profiles

CREATE PROFILE