Michelle Fowler

• Migrated processes to fully integrate controls from legacy entity acquired by WEX.
• Monitored, Reported and Drafted HIPAA breach and security incident communications.
• Managed compliance efforts with IRS, DOL and CMS regulations, reporting and audits.
• Reduced risk exposure for the company by identifying and addressing areas of noncompliance.
• Reviewed legal documents, system files, and other records to assess compliance and potential risk.
• Prepared records and data for regular HIPAA, and SOC 1 Type II audits.
• Reviewed and Approved Regulatory assessments for potential third party vendors.

• Supported Ascensus Chief Compliance Officer to establish and maintain sound compliance processes in their newly acquired health division.
• Analyzed and identified risk areas to determine compliance with applicable laws and regulations.
• Managed compliance efforts in assessing and responding to claims appeals, regulatory CMS reporting and HIPAA and SOC 1 Type II audits.
• Implemented effective compliance policies and procedures to meet regulatory requirements including revisited IRS rules for welfare benefit administration.
• Addressed compliance issues by developing and implementing corrective action plans in response to annual HIPAA Assessments.
• Managed my team to successfully facilitate SOC 1 Type II process audits for third party administrator of welfare benefit claims and COBRA administration.
• Achieved recognition for leadership in compliance, setting benchmark in industry for best practices.
• Advanced organizational compliance maturity by benchmarking against industry standards and implementing best practices.
• Coordinated with legal teams to interpret regulatory changes, ensuring timely compliance adjustments.

I was promoted internally from a manager to a Sr. manager to a Director as I built the theCompliance program for a managed vision care third party administrator (TPA) with $2 B in gross billings and $50 MM in OI.

• Managed a team of 7 people to conduct policy & procedure writing for Fraud Waste and Abuse(FWA), compliance program training, a sub-contracted vendor management program, and process improvement in functional operations
• Facilitated external regulatory and client audits and internal monitoring of records and data for annual HIPAA assessments.
• Prepared and presented comprehensive reports to upper management and audit team, covering issues and recommendations.
• Managed client contractual and regulatory compliance to meet standards of CMS Medicare regulations, HIPAA, and state Departments of Insurance (DOI)
• Advised clients on best practices and served as project manager for all process improvements and regulatory initiatives.