SUNDEE GOMEZ
Thornton,CO
Summary
Dynamic Compliance Manager at Sagility with a proven track record in developing robust compliance policies and enhancing training completion rates to over 95%. Skilled in regulatory compliance and effective communication, I excel in leading cross-functional teams to achieve strategic objectives and drive continuous improvement in compliance initiatives.
Overview
17
17
years of professional experience
Work History
Compliance Manager
Sagility
Westminster, CO
01.2023 - Current
- Developed compliance policies to align with industry regulations and standards.
- Collaborated with cross-functional teams to address compliance-related issues effectively.
- Trained staff on compliance procedures and best practices to enhance understanding.
- Monitored changes in regulations to update compliance protocols as necessary.
- Managed documentation processes for audits and regulatory reporting requirements efficiently.
- Led investigations into compliance breaches, coordinating responses with relevant departments.
- Developed and implemented policies and procedures to ensure compliance with applicable laws, regulations, standards, and best practices.
- Assisted with the development of training materials for employees regarding compliance requirements.
- Completed internal and external audits according to established procedures.
- Assisted with investigations into allegations of fraud or misconduct within the organization.
- Served as a primary contact with regulators during external audit reviews.
- Supported strategic development and objective setting by analyzing audit outcomes and generating actionable recommendations.
- Facilitated meetings between stakeholders, including executive leadership, legal counsel, and department heads, to discuss compliance matters.
- Participated in industry forums and conferences related to compliance topics.
- Currently studying to complete certification in healthcare compliance (CHC).
- Collaborated with legal & procurement to implement the US Vendor Management Program. Identified over 700 vendors, and categorized vendors based off of established vendor risk criteria.
- Produced FDR tools such as annual attestation forms and FDR guides.
- Established criteria to audit and monitor those vendors that fell under the FDR category according to contractual agreements and CMS criteria.
- Manage, organize, and monitor the internal compliance hotline phone and email.
- Collaborated with the Compliance Officer to coordinate appropriate and efficient investigation and response to the incoming reports.
- Deep understanding of the HHS-OIG General Compliance Guidelines and Federal Sentencing Guidelines requirements for an effective compliance program.
- Improved annual Compliance training from 60% overall completion to over 95% completion through consistent reporting, tracking, and analysis of training rates.
- Pushed teams to 100% completion rate with new hire compliance training to meet CMS standards.
- Partnered with HR to monitor and audit OIG/GSA employee screening and identified gaps that were pushed to closure.
- Assisted with revision of reports, policies, and procedures to establish clarity and concise reporting.
- Maintained Quarterly Compliance Committee meeting agenda and minutes. Focused on planning and organizing the input for the meeting from various department heads throughout the organization to increase the participation to over 50% in 9 months.
- Authored quarterly compliance newsletter.
Quality/Compliance Specialist
Sagility
Westminster, CO
04.2008 - 01.2023
- Responsible to support Compliance for daily auditing and monitoring of SNP member HRA status and completion in addition to auditing and monitoring employee calls to members.
- Designed new audit protocol for SNP HRA program compliance.
- Participated in external audits and composed Corrective Action Plan (CAP) response to audit findings.
- Led NCQA accreditation remediation demonstrating self-motivation as well as a team player with a bias for action and a strong sense of ownership. Increased company's ability to score 20% higher in the next review.
- Performed quality call audits of assigned staff members and provided feedback to raise member experience survey to above target range of 90% satisfaction.
- Utilized process improvement techniques to revise the call audit Interpretation Standards to promote better inter-rater reliability and increase call scores to 90% or higher.
- Policy and Procedure analysis to increase accuracy and clarity in documentation for staff implementation into practice, this increased call scores by 5%.
- Identified and recommended performance improvement opportunities.
- Conducted internal audits to assess adherence to compliance requirements.
Volunteer/ Practicum Experience
Broomfield Public Health and Environment
Broomfield, CO
02.2017 - 06.2017
- Worked with the public health department to support various initiatives:
- Updated Norovirus, tularemia, rabies, head lice, & chicken pox handouts and letters to be succinct and grammatically correct in order to have a greater impact on the community served.
- Supported statewide emergency response to screen and dispense necessary items to the public.
Education
MASTER'S DEGREE - Public Health
Grand Canyon University
Phoenix06-2017
Bachelor of Science - Biology
Metropolitan State University of Denver
Denver, CO12-2012
Skills
- Communication
- Critical thinking
- Accountability
- Teamwork
- Excel
- Microsoft Word
- Organization
- MMCM chap 9 & 21 for compliance
- Microsoft Office Suite
- Power Point
- Six Sigma
- Process development
- Legislative monitoring
- Training delivery
- Compliance initiatives
- Compliance auditing
- Incident response
- Compliance monitoring
- Sanctions screening
- Regulatory compliance
- Policy development
- Internal auditing
- Investigative reporting
- Vendor management
- Compliance training
- Effective communication
- Corrective action planning
- Team collaboration
- Policy revision
Affiliations
HCCA, Compliance Manager, 02/01/23, 02/01/24
Professional Development
- Leadership Training - SHE Leads, Completed leadership training workshop with Sagility, 01/01/24
- HIPAA / PHI / IHII/ HI Workshop, HCCA/SCCE, 01/01/24
Accomplishments
- SHE Leads Leadership Certificate
- Torchbearer Award
Timeline
Compliance Manager
Sagility
01.2023 - Current
Volunteer/ Practicum Experience
Broomfield Public Health and Environment
02.2017 - 06.2017
Quality/Compliance Specialist
Sagility
04.2008 - 01.2023
MASTER'S DEGREE - Public Health
Grand Canyon University
Bachelor of Science - Biology
Metropolitan State University of Denver
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