Myesha Hill
Buckeye,AZ
Summary
Adaptable, collaborative, and strategic professional skilled in leading cross-functional teams and driving successful project delivery. 7+ years of experience in developing and implementing effective compliance strategies to ensure adherence to regulatory requirements and industry standards. Demonstrated ability to manage complex projects, mitigate risks, and achieve project objectives while maintaining a strong focus on quality assurance in alignment with organizational strategic goals.
Overview
15
15
years of professional experience
1
1
Certification
Work History
Senior Compliance Specialist
Optum
03.2022 - Current
- Led and managed audit engagements by facilitating kick-off meetings, conducting budget analysis, and ensuring alignment between stakeholders and cross-functional teams on audit requirements and expectations
- Served as valuable compliance resource to functional business areas continuously improving processes to mitigate non-compliance risks
- Conducted legal research to assess impact of regulatory changes on business operations and develop strategic recommendations to champion change
- Managed consolidation and organization of documentation following a merger to ensure compliance with regulatory requirements and industry standards.
- Spearheaded implementation of audit/medical record dashboard in Onspring to enhance transparency and accountability
- Established EHR program and governance; Created visual deliverables and produced training for internal records staff to optimize medical record process
- Fostered relationships with internal and external stakeholders to report status of projects and program health.
- Updated spreadsheets with latest data to enhance strategic planning.
- Stayed current with latest changes to applicable regulatory standards and company procedures.
- Developed improvement and corrective action plans to bring operations in line with requirements.
- Kept informed regarding pending industry changes, trends or best practices.
- Assisted with development of compliance objectives and strategies.
- Conducted periodic compliance audits and reviews to identify areas of improvement.
- Developed risk assessment models to identify potential compliance risks.
- Evaluated and monitored delegation partnerships to support compliance.
- Identified gaps in existing compliance processes and recommended updates.
- Maintained and archived regulatory paperwork.
- Implemented regulatory guidance procedures for Health Information Exchange.
- Wrote or updated standard operating procedures, work instructions or policies.
- Prepared documentation and records for upcoming audits and inspections.
- Assisted investigation and risk management teams with fraud investigations and risk identification.
- Backed data security and information privacy efforts.
- Responsible for tracking and reporting on corporate compliance training completion and resulting corrective actions for non compliance.
Senior Audit Analyst, Corporate Compliance & Audit
Oscar Health
08.2020 - 02.2022
- Oversaw Internal Audit activities, including risk assessments, walkthroughs, and tests of business controls
- Identified control gaps in processes, procedures and systems through in-depth research and assessment and suggested methods for improvement.
- Planned and executed follow-up audits at appropriate intervals.
- Coordinated, managed and implemented auditing projects and prepared for evaluation.
- Performed observations and evaluated supporting documents to supplement audit findings.
- Followed established auditing processes to meet internal and regulatory requirements.
- Adapted plans and schedules to meet changing priorities of work objectives, resources and workload demands.
- Evaluated and addressed business control deficiencies by performing root cause analysis and monitoring management's remediation efforts; Led strategic initiatives to improve controls and ensure compliance
- Prioritized audits based on Compliance Risk Assessment results; Conducted interviews with personnel to gather audit information; Collaborated with process owners to understand operations and internal control environment
- Generated written audit reports; Identified risks and recommended improvements for effectiveness and risk mitigation
- Delivered strategic guidance to influence development of policies and procedures with compliance implications; Updated and/or introduced required forms and disclosures
- Communicated with staff to obtain necessary information for audits.
- Interpreted state and federal laws, accepted auditing principles and procedures and program standards to audited materials and data to detect non-compliance and facilitate recommendations.
- Prepared working papers, reports and supporting documentation for audit findings.
Lead Compliance Coordinator
Avesis
10.2015 - 08.2020
- Completed monthly internal audits of key operational departments and reported monthly accuracy feedback to stakeholders (Claims, Credentialing, Utilization Management, Claims Processing Systems)
- Performed delegation (external) audits for Medicaid/Medicare administered routine dental and vision plans across multiple states
- Educated employees by conducting compliance training programs and issuing periodic communications to refresh knowledge of compliant work practices.
- Compiled internal information for compliance audit by reviewing company policy documentation, non-compliance reports and investigations into questionable conduct.
- Prepared and presented comprehensive reports to upper management and audit team, covering issues and recommendations.
- Delivered subject matter expertise for internal and external customers on compliance best practices and quality control.
- Liaised with clients to identify and target inefficiencies in areas of risks and business controls, process gaps and workflow discrepancies.
- Developed and implemented audit tracking dashboard within SharePoint by streamlining document management process and ensuring accuracy and accessibility of audit records
- Analyzed provider contracts to review terms and conditions and identify discrepancies and inconsistencies in claims reimbursement; Identified patterns and trends to ensure accurate payment of claims and minimize financial risk
- Partnered with operational business units to create and implement procedures to promote audit submission accuracy.
- Maintained effective working relationships with regulatory authorities, suppliers and customers.
- Managed compliance efforts, reporting and audits.
- Reviewed documents, files, transcripts, and other records to assess compliance and potential risk.
- Developed or tracked quality metrics.
Accounts Receivable Representative
Medical Information Managment Systems
08.2009 - 04.2015
- Communicated with customers to identify and resolve outstanding payments.
- Prepared and mailed invoices to customers, processed payments, and documented account updates.
- Reviewed accounts on monthly basis to assess aging and pursue collection of funds.
- Reconciled accounts receivable ledger to verify payments and resolve variances.
- Followed up overdue payments and payment plans from clients to establish good cash flow.
- Monitored accounts to verify compliance with payment terms and schedules.
- Presented audit findings to accounting manager after reviewing results and paperwork.
- Reconciled accounts, managed audits and updated financial records with remarkable accuracy.
- Examined patients' insurance coverage, deductibles, insurance carrier payments and remaining balances not covered under policies when applicable.
- Liaised between patients, insurance companies, and billing office.
- Communicated with insurance providers to resolve denied claims and resubmitted.
- Collected payments and applied to patient accounts.
- Researched CPT and ICD-9 coding discrepancies for compliance and reimbursement accuracy.
- Communicated with patients for unpaid claims for HMO, PPO and private accounts and delivered friendly follow-up calls for proper payments to contracts.
- Posted and adjusted payments from insurance companies.
- Analyzed complex Explanation of Benefits forms to verify correct billing of insurance carriers.
- Located errors and promptly refiled rejected claims.
- Evaluated patients' financial status and established appropriate payment plans.
- Precisely completed appropriate claims paperwork, documentation and system entry.
- Communicated effectively and extensively with other departments to resolve claims issues.
- Adhered to established standards to safeguard patients' health information.
- Reviewed accounts on monthly basis to assess aging and pursue collection of funds
Education
High School Diploma -
South Mountain High School
Phoenix, AZ05.2000
Skills
- Regulatory Understanding
- Risk Management
- Cross-functional Collaborations
- Quality Management
Accomplishments
- Used Microsoft Excel to develop inventory tracking spreadsheets.
- Established EHR program and governance; Created visual deliverables and produced training for internal records staff to optimize the medical record process.
Certification
- Google Data Analytics Certification
- Project Management Certification
Professional Development
- Foundations of Project Management
- Ask Questions to Make Data-Driven Decisions
- Project Initiation: Starting a Successful Project
- Foundations: Data, Data, Everywhere
Affiliations
- Health care Compliance Association
- ISC2
- AAPC
Timeline
Senior Compliance Specialist
Optum
03.2022 - Current
Senior Audit Analyst, Corporate Compliance & Audit
Oscar Health
08.2020 - 02.2022
Lead Compliance Coordinator
Avesis
10.2015 - 08.2020
Accounts Receivable Representative
Medical Information Managment Systems
08.2009 - 04.2015
High School Diploma -
South Mountain High School