RHONDA HAUSFELD
Riverside,OH
Summary
High performing, detail-oriented professional with expertise in health care compliance. Advanced knowledge of regulatory compliance with state and federal regulations, including Medicare and Medicaid. Quality driven and hard working with proven skills in identifying issues/trends, developing resolutions and implementing corrective actions in a timely manner.
Overview
21
21
years of professional experience
1
1
Certification
Work History
Compliance Specialist
Buckeye Health Plan
Columbus, OH
05.2020 - Current
- Manage, investigate, and mitigate privacy-related incidents, and complete required reporting to affected parties, as well as State and Federal regulators.
- Serve as the Compliance Department's regulatory email box support for regulator inquiries, and manage the timely response to the inquiry.
- Manage and respond to requests for information from the Ohio Department of Insurance for the plan.
- Research ad hoc inquiries against state contracts and regulations to ensure compliance for the plan.
- Manage any Data Leak Prevention (DLP) incident inquiries for the plan.
- Support the conflict-of-interest submissions review process for plan employees.
- Develop and maintain compliance policies and procedures to ensure adherence to federal and state regulatory requirements.
- Investigate ethics and compliance issues received from the hotline.
- Support audit initiatives with appropriate compliance documentation.
- Ensure compliance with contractual requirements, and federal and state government reporting and regulations across all plan products.
- Serve as a compliance resource for day-to-day operations.
Manager, Privacy
Caresource
Dayton, Ohio
10.2019 - 04.2020
- Oversee and ensure all HIPAA privacy incidents are thoroughly documented and appropriately mitigated, as required by state or federal contractual obligations.
- Maintain organizational HIPAA privacy policies and procedures, including the annual review process.
- Responsible for the relationship between privacy and key business stakeholders, and accountable for the teams' delivery of associated business services.
- Support audit and accreditation initiatives by providing necessary documentation or other support needs.
- Serve as a resource for all levels of the organization to aid with privacy-related matters.
- Manage day-to-day operations, including supervision and assignment delegation of an eight-member team.
Compliance And Privacy Manager
Premier Health
Dayton, OH
08.2018 - 10.2019
- Responsible for oversight of all hospital compliance and privacy-related program activities, including policy and procedures review and development, auditing and monitoring activities, enforcement and corrective action application.
- Managed the risk assessment process, in alignment with departmental procedures.
- Conducted compliance, fraud, waste, and abuse, and HIPAA employee training for patient-facing workforce areas to ensure compliance.
- Formulate detailed recommendations based on audit findings for business owners and leadership teams to support the annual compliance work plan process.
- Oversight of the conflict of interest process, excluded provider monthly reviews, and driving compliance data analytics programs.
- Served as a resource for all levels of the organization to aid with compliance and privacy-related matters.
- Oversight of compliance and privacy staff.
Privacy Officer
Premier Health
Dayton, OH
12.2015 - 08.2018
- Responsible for all privacy-related activities, including, but not limited to: policy implementation, training, investigating privacy concerns, regulatory change updates, and privacy reporting for all Premier entities.
- Provide leadership and guidance in matters of privacy and confidentiality, including the enforcement of federal rules governed by privacy and confidentiality.
- Collaborate with the Information Security Officer on security vulnerability issues related to HIPAA.
- Coordinate investigative activities with leadership to ensure corrective action measures are consistent.
- Participate in internal committees regarding appropriate system access in order to ensure patient privacy and confidentiality.
- Oversight of privacy staff and their daily activities.
Reimbursement Analyst II
Premier Health
Dayton, OH
04.2014 - 12.2015
- Oversight of revenue integrity of hospital departments for accuracy and compliance.
- Analysis of CPT and HCPCS code changes based on Medicare/Medicaid regulations, and their application in the hospital revenue cycle.
- Educated department leadership on all federal and state requirements, with proper charging of hospital procedures.
- Developed charge analysis for the annual hospital rate increase.
- The project team lead, in collaboration with IT, is responsible for the development of appropriate system processes, validation of system updates, and implementation of all core claim system changes.
- Responsible for filing appropriate documentation for provider-based status of hospital departments.
- Developed and implemented processes, policy and workflow in support of revenue cycle integrity.
Corporate Compliance Liaison
CareSource
Dayton, OH
06.2012 - 04.2014
- Oversight of the Corporate Compliance Program to identify areas of compliance vulnerability and risk.
- Developed and implemented corrective action plans with operational business owners to correct regulatory and/or compliance deficiencies.
- Conducted routine monitoring and auditing activities.
- Collaborated with legal personnel to investigate compliance concerns.
- Coordinated appropriate document responses for on-site and off-site state and federal audits.
- Performed compliance, fraud, waste and abuse and HIPAA employee training to ensure 100% workforce compliance.
- Primary operational compliance resource, with executive leadership, to promote awareness of all state and federal requirements.
SIU Data Analyst and Michigan Fraud Compliance Officer
CareSource
Dayton, OH
05.2007 - 06.2012
- Developed data queries and presented a comprehensive analysis for senior management, with data trends and schemes of potential fraud, waste, and abuse.
- Audited medical and pharmacy claims, prior authorizations, and member/provider grievances data to identify trends of non-compliance.
- Primary liaison to the State of Michigan's regulatory agency for program integrity reporting, auditing, and data analysis.
- Primary department liaison on corporate projects and Special Investigations Unit (SIU) initiatives.
- Coordinated appropriate document responses for on-site and off-site state agency compliance audits.
- Supervised associate investigators and interns on data analysis and compliance requirements.
Senior Investigator
CareSource
Dayton, OH
01.2006 - 05.2007
- Conducted investigations of potential fraud, waste, and abuse concerns. Investigations included data analysis, medical record auditing, interviews of suspects and witnesses, and on-site inspections.
- Prepared detailed investigative reports for legal counsel in preparation for litigation.
- Implemented a departmental investigative case management database in order to track and trend fraud, waste, and abuse issues.
- Networked with investigators within the health care industry (Attorney General's Office, Ohio Medical Board, FBI, and other health plans, etc.).
Fraud Data Analyst
CareSource
Dayton, OH
04.2004 - 12.2005
- Documented all reported allegations of fraud, waste, and abuse through various sources (i.e., Hotline, Email, Fax, etc.).
- Utilized data mining resources to identify inappropriate billing patterns of members and providers of medical services.
- Developed case summaries for executive management review.
- Addressed and coordinated system enhancements as they related to fraud, waste, and abuse initiatives.
Education
Bachelor of Science - Human Resource Management
Wright State University
Fairborn, OHSkills
- Detail oriented
- Critical thinking and analytical skills
- Leadership experience
- Ability to work independently or as a team
- Problem-solving
- High level of investigative skills
- Epic/Facets and SAS experience
- Proficient in Microsoft applications
Certification
- Health Care Compliance Association - (HCCA) - 2011 - Certificate (CHC)
- Heath Care Anti- Fraud Association Designation - 2005 - Certificate (HCAFA)
Timeline
Compliance Specialist
Buckeye Health Plan
05.2020 - Current
Manager, Privacy
Caresource
10.2019 - 04.2020
Compliance And Privacy Manager
Premier Health
08.2018 - 10.2019
Privacy Officer
Premier Health
12.2015 - 08.2018
Reimbursement Analyst II
Premier Health
04.2014 - 12.2015
Corporate Compliance Liaison
CareSource
06.2012 - 04.2014
SIU Data Analyst and Michigan Fraud Compliance Officer
CareSource
05.2007 - 06.2012
Senior Investigator
CareSource
01.2006 - 05.2007
Fraud Data Analyst
CareSource
04.2004 - 12.2005
Bachelor of Science - Human Resource Management
Wright State University
- Health Care Compliance Association - (HCCA) - 2011 - Certificate (CHC)
- Heath Care Anti- Fraud Association Designation - 2005 - Certificate (HCAFA)
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