Pamela L. Rundell
Dallas,Texas
Summary
Experienced healthcare professional specializing in compliance, regulatory affairs, legal processes, delegation, vendor management, and managed care. Expertise in collaborating with federal and state regulatory agencies, including CMS, DOJ, HHSC, OCR, OIG, and TDI. Experience in conducting NCQA and JCAHO accreditation audits, as well as proficiency in Medicare, Medicare Advantage, and Medicaid. Possess a strong understanding of Systems Improvement Agreements (SIA) and Corporate Integrity Agreements (CIA). Skilled in driving multi-disciplinary improvement efforts and implementing enterprise-wide processes for monitoring, auditing, and risk mitigation. Adept at identifying high-impact areas to develop strategies that propel performance improvement initiatives and deliver organizational value. Recognized as a subject matter expert in large, matrixed organizations, with a proven track record of engaging stakeholders, senior leadership, c-suite executives, and board members. Additionally, brings deep expertise as a senior litigation paralegal, with experience in medical malpractice, insurance defense, and employment law, in both large firms and in-house counsel settings. Committed to upholding company policies, procedures, mission, values, ethical standards, and codes of conduct.
Overview
12
12
years of professional experience
1
1
Certification
Work History
Senior Regulatory Compliance Analyst
Texas Health Resources - Texas Health Physicians Group
04.2024 - Current
- Member of the Enterprise Risk Management | Regulatory Change Management workgroup which is responsible for the development, deployment, implementation, and auditing of all applicable regulatory matters across the entire organization such as: Stark, Anti-Kickback, issued governmental executive orders
- Responsible for Annual Conflict of Interest Program for ~ 1200 providers including management plans and letters / verification of all reported conflicts against CMS Open Payments portal; prepare report on same for presentation to corporate compliance and legal committees for review and approval of conflict management for stated conflicts; prepare management plan letters for the same
- Review and investigate reported compliance matters to compliance hotline / portal (Navex); collaborate with internal business owners to analyze and address reported investigations; perform necessary regulatory research for the same
Director, Regulatory Compliance - Delegation | Vendor Oversight
Southwestern Health Resources ACO / CIN (Texas Health Resources and UT Southwestern)
10.2022 - 12.2023
- Oversight of enterprise First-Tier, Downstream, and Related Entities (FDRs), delegated entities, and vendors (e.g., pharmacy, vision), ensuring compliance with all state and federal regulations. Responsibilities included managing audits, mock audits, attestations, and monitoring adherence to FWA, HIPAA, Stark Law, and other regulatory requirements or violations.
- Development of an annual risk assessment and corresponding work plan to mitigate risks and improve operational efficiency, aligned with the OIG Annual Work Plan and the Seven Elements of an Effective Compliance Program.
- Creation and distribution of the organizational FDR Guidelines Toolkit to standardize processes and enhance compliance frameworks.
- Collaboration with corporate procurement, contracting teams, in-house and external counsel, and operations to draft critical documentation, including delegation amendments, service level agreements, memoranda of understanding, letters of agreement and intent, non-disclosure agreements, and business associate agreements for delegated entities, material subcontractors, and vendors.
- Reporting, auditing, and reconciling compliance data and metrics for analysis of key performance indicators (KPIs) and contractual performance metrics.
- Partnering with internal operational departments to ensure proper configuration of lines of business, products, delegated credentialing, claims, and resolution of network, provider, member, billing, analytics, and appeals/grievance issues.
- Managing direct reports by overseeing training, mentorship, performance reviews, merit cycle processes, and other personnel-related matters.
Manager, Regulatory Compliance
Care 'N Care Health Plan
10.2021 - 10.2022
- Chair Delegation Oversight Committee for the health plan with final report out to Executive Leadership
- Reporting of deliverables to Delegation Oversight Committee, Senior and Executive Leadership
- Responsible for oversight of enterprise FDRs, delegated entities, and vendors for compliance with all state and federal regulatory agencies including all audits / mock audits / attestations under these regulatory agencies as well as oversight of monitoring for FWA, HIPAA, Stark Law, and other regulatory matters / violations
- Creation of Risk Assessment Tool and Audit work plan for delegated entities / providers/ vendors
- Project management of implemented Corrective Action Plans with responsible business owners including remediation, adherence to timetables, monitoring
- Collaborate with corporate procurement / contracting, in-house and outside counsel, and health plan operations for drafting of provider services agreements, hospital service agreements, delegation amendments, service level agreements, memoranda of understanding, letters of agreement, letters of intent, non-disclosure agreements, and business associate agreements for health plan delegated entities, material subcontractors and vendors
- Management of direct reports includes all training, mentorship, reviews, merit cycle, and other personnel matters
Corporate Compliance and Ethics Department Consultant
Parkland Health & Hospital System
03.2021 - 09.2021
- Preparation of daily and weekly analytics reports regarding cases reported to the Integrity and Ethics Hotline for assessment during daily and weekly meetings
- Review and update current cases in the Integrity and Ethics Hotline portal (Navex) for consistency for deliverables for committee meetings
- Audit reported investigations for crosswalk functionality on same / similar stated cases for measurement of trending issues (e.g., leading and lagging indicators, resolution time, case type, outcome, etc.)
- Development of agile analytics tools for verification of necessary data points / metrics to establish reliable compliance data
- Assist Revenue Cycle Compliance Director with Recovery Audit Contractor (RAC) Audits and develop appropriate project management plan to comply with required audit and government regulations
Director, Regulatory Compliance - Delegation | Vendor Oversight
Molina Healthcare of Texas, Inc.
01.2017 - 12.2020
- Chair of the Delegation Oversight Committee for the Texas health plan, delivering final reports to the Executive Quality Committee.
- Oversee all health plan delegated entities, encompassing approximately 45% of the Texas health plan network (~32,000 providers), ensuring compliance with state and federal regulations. Responsibilities included managing audits, mock audits, and monitoring adherence to FWA, HIPAA, Stark Law, and other regulatory requirements or violations.
- Manage oversight of vision, dental, relocation, and health plan-specific vendors (e.g., dental, vision, value-add services [VAS], electronic visit verifications [EVV]).
- Supervise and gather all required information from delegated entities, material subcontractors, and vendors for inclusion in state-mandated Request for Proposals (RFPs).
- Maintain the contracting repository for all delegated entities, material subcontractors, and vendors.
- Develop and implement departmental policies and procedures, presenting them annually to the Executive Quality Committee and Delegation Oversight Committee for review and approval.
- Collaborate with corporate procurement, contracting teams, in-house and external counsel, and health plan operations to draft key agreements, including provider services agreements, hospital service agreements, delegation amendments, service level agreements, memoranda of understanding, letters of agreement and intent, non-disclosure agreements, and business associate agreements for delegated entities, material subcontractors, and vendors.
- Coordinate with internal operational departments to ensure the correct configuration of lines of business, products, delegated credentialing, claims, and resolution of network, provider, member, billing, analytics, and appeals/grievance issues.
Executive Director of Operations
The Cooper Institute
06.2015 - 11.2016
- Managed all aspects of the Adult Education budget, including forecasting, accruals, analysis of leading and lagging indicators, expenses, variances, and FTE percent efforts.
- Initiated and executed a cost business analysis project and competitor comparison, resulting in a successful proposal to senior leadership to expand Adult Education class offerings and products. This approval was projected to generate a 15-20% increase in revenue for the division and the company.
- Directed and supervised the initiative to update Adult Education course manuals, leading the RFP process for vendor selection. Presented the final vendor to senior leadership, gaining endorsement for new manuals deployed in January 2017, creating a significant revenue opportunity for the division and the company.
- Oversaw the development, implementation, maintenance, and revision of company policies and procedures, ensuring compliance and operational consistency across the organization.
- Ensured departmental compliance with all applicable federal, state, and industry laws, regulations, and standards (e.g., FERPA, HIPAA) across all divisions.
- Reviewed and edited terms of use, data use agreements, business associate agreements, and enterprise contracts, collaborating with external counsel as needed.
- Monitored and audited company trademarks, trademark infringement, and trademark renewal dockets; collaborated closely with external counsel to ensure protection and compliance.
- Oversaw and audited NIH Human Subjects Training requirements for all employees, ensuring adherence to regulatory standards.
- Assisted Principal Investigators with oversight of funded grant projects, managing both pre- and post-submission processes.
- Managed direct reports, providing training, mentorship, performance reviews, merit cycle oversight, and addressing other personnel-related matters.
Compliance Reporting Manager, Corporate Compliance and Ethics Department
Parkland Health and Hospital System
03.2013 - 10.2014
- Oversaw the reporting of all events mandated under the System Integrity Agreement (SIA) and Corporate Integrity Agreement (CIA), developing and presenting compliance workflow processes required under the CIA to the Chiefs of Parkland Health and Hospital System and senior leadership.
- Collaborated with departmental leaders to create a standardized institutional nomenclature crosswalk, ensuring alignment with industry standards and compliance with federal and state agency requirements, including OIG mandates under the CIA.
- Provided comprehensive compliance support for CMS investigations, surveys, immediate jeopardy statuses, and their remediation efforts.
- Demonstrated expertise in identifying root cause issues and implementing effective corrective actions, while tracking and trending issues to ensure sustainable remediation.
- Audited, reconciled, and reported compliance data and metrics to external consultants, ensuring accuracy and reliability.
- Delivered preliminary notifications of reportable events to federal and state agencies for external consultants.
- Compiled and distributed monthly reports of federal and state agency-required submissions to the Board of Managers, Executive Compliance Committee, Governance and Ethics and Compliance Committee, and the Quality of Care and Patient Safety Committee.
- Spearheaded the design and development of the departmental regulatory communications database in collaboration with an external vendor, coordinating with Compliance Directors on CBA, statements of work, ROI analyses, implementation, and ongoing maintenance. Monitored, tracked, and audited the database to ensure timely reporting to federal and state agencies and verified internal reporting, summarizing results for Compliance Directors.
- Worked closely with the Legal Affairs Department, Internal Audit, and Records Management teams to facilitate risk mitigation and audit initiatives effectively.
Education
Bachelor of Arts -
Southern Methodist University
Dallas, TXSkills
Professional Skills
* Compliance monitoring
* Documentation review
* Compliance monitoring
* Effective contract negotiation
* FDR monitoring
* Legal and regulatory research
* Management of conflicts of interest
* OIG annual work plans
* Provider delegation expertise
* Regulatory change management
* Risk mitigation strategies
*Third party risk assessment
* Training facilitation expertise
* Vendor management expertise
Interpersonal Skills
° Analytical reasoning
° Collaborative teamwork
° Development-focused mentorship
° Executive leadership engagement
° Organizational expertise
° Prudent financial governance
° Resolution-focused negotiator
° Strong interpersonal abilities
Certification
- CHC - Certified in Healthcare Compliance through HCCA
- CHRC - Certified in Healthcare Research Compliance through HCCA
Who's Who in American Law
ABA-certified litigation paralegal with over 20 years of experience across top law firms, corporate legal departments, and in-house counsel for major companies like Southwest Airlines. Expertise spans commercial litigation, insurance defense, medical malpractice, corporate law, and labor and employment law.
Timeline
Senior Regulatory Compliance Analyst
Texas Health Resources - Texas Health Physicians Group
04.2024 - Current
Director, Regulatory Compliance - Delegation | Vendor Oversight
Southwestern Health Resources ACO / CIN (Texas Health Resources and UT Southwestern)
10.2022 - 12.2023
Manager, Regulatory Compliance
Care 'N Care Health Plan
10.2021 - 10.2022
Corporate Compliance and Ethics Department Consultant
Parkland Health & Hospital System
03.2021 - 09.2021
Director, Regulatory Compliance - Delegation | Vendor Oversight
Molina Healthcare of Texas, Inc.
01.2017 - 12.2020
Executive Director of Operations
The Cooper Institute
06.2015 - 11.2016
Compliance Reporting Manager, Corporate Compliance and Ethics Department
Parkland Health and Hospital System
03.2013 - 10.2014
Bachelor of Arts -
Southern Methodist University
Similar Profiles
Kylee CelisKylee Celis
LVN Lead at Texas Health Physicians GroupLVN Lead at Texas Health Physicians Group
Lucero SaldañaLucero Saldaña
Medical Office Lead at Texas Health Physicians Group (THPG) Clinic #18810Medical Office Lead at Texas Health Physicians Group (THPG) Clinic #18810
Genivia Garcia DeLeonGenivia Garcia DeLeon
Nationally Registered Certified Medical Assistant at Texas Health Physicians GroupNationally Registered Certified Medical Assistant at Texas Health Physicians Group
Stephanie NanceStephanie Nance
Head of Business Strategy (Finance) at Smart Business ConceptsHead of Business Strategy (Finance) at Smart Business Concepts
KEVIN TRUONGKEVIN TRUONG
Patient Care Technician Course at R.L. TURNER HIGH SCHOOLPatient Care Technician Course at R.L. TURNER HIGH SCHOOL