YANA KHASSANOV
Monroe Township,New Jersey
Summary
Skilled Healthcare Compliance Professional who ensures the organization I work for comply with laws and regulations that are set forth by the state and federal government. Respected for identifying risks for non-compliance, mitigating risks, training employees on compliance issues, maintaining confidence, implementing company policies, and preparing the company for internal and external audits by ensuring audit universes are efficient and everyone feels confident for audit proceedings.
Overview
17
17
years of professional experience
Work History
Assistant Vice President of Compliance
RiverSpring Health Plans
12.2017 - Current
- Completed filings and upheld strict compliance with regulatory agencies and supervisors.
- Maintain relationship with CMS and DOH by being primary point of contact and responsible for overall compliance with Medicare rules and regulations.
- Monitor and implement regulatory reporting guidance and changes within organization, including review of all delegate data and feedback for delegates preparing data for new products.
- Facilitate, manage, and prepare Medicare regulatory compliance activities, including: regulatory reporting, data submissions, marketing materials, plan websites review, BID submission, external audits from Centers for Medicare and Medicaid Services (CMS) and their consultants such as Data Validation Audit, Timeliness Management Program Audit, Acumen and Part D Monitoring efforts
- Enhanced collaboration between team members by implementing innovative communication tools and fostering an open dialogue culture.
- Managed and executed internal and external audits by ensuring that requested audit universes are efficient and include requested information for scope of audit.
- Established high-performance culture within the team by setting clear expectations and providing regular feedback on individual performance contributions.
- Managed diverse portfolio of projects, ensuring that each project met established quality standards and delivered expected results on time and within budget.
- Reduced costs by negotiating vendor contracts and identifying areas for potential savings within department budgets.
- Prepare and handle submission of marketing materials for government approval, coordinate translations and ensure compliance with Medicare Marketing Guidelines for marketing materials.
- Prepare regular compliance updates to Board of Directors.
- In charge of quarterly Medicare Compliance Committee Meetings.
- Participant in Quality and Star Ratings Committee that discusses and implements ideas to enhance plan performance and improve member adherence to measures set by CMS.
- Prepare and write new plan applications and supporting documents for senior management review; draft policies, procedures and documents for annual work plan review and risk assessment.
- Oversee direct reports by hiring, mentoring, training and evaluating performance.
Assistant Director Regulatory Compliance
Elderplan/HomeFirst
04.2013 - 12.2017
- Supervise Regulatory Compliance staff and report directly to AVP of Regulatory Compliance; overseeing various regulatory compliance activities for Medicare products (D-SNP, I-SNP, MA-PD), integrated products (MMP, MAP) and Managed Long Term care plan.
- Liaison between Regulatory Compliance department and regulatory agencies (CMS, DFS, DOH and Ombudsman) for member/provider complaint related investigation resolution correspondence: Investigated, closed and recommended CAPs for regulatory complaints; reported complaint trends and CAP progress in meetings with various business areas. Tracked stars metric related to CTM complaints.
- Complete comprehensive audit/investigations and recommend corrective actions to address areas of non-compliance for several departments, including Appeals and Grievances, Medical Management, Customer Service, Provider Network, Provider relations, Member Operations, Claims, Pharmacy and Sales Operations.
- Assist business owners and provide research support, involving both Medicare and Medicaid regulations and guidance in development of policies and procedures to meet regulatory requirements and to decrease compliance deficiencies.
- Assist AVP of Compliance during CMS Program Mock Audit by collecting and reviewing universe data from all business owners and vendors, coordination and documentation for several aspects of mock audit, tracking all deliverables and noting all findings during audit for dissemination to business areas and upper management. Actively involved in preparation for Compliance Program Effectiveness review, including documentation and submission of CPE universe and tracers.
- Facilitate and participate in organization workgroups, meetings and trainings.
- Responsible for compiling, validating and uploading data to HPMS for annual submission of Elderplan’s Part C and D data validation; coordinate, validate and submit Part C and D reports, including review of any related SQL queries and workflows to ensure compliance with relevant technical specifications. Lead Part C and D validation activities, including quality review of all submissions to Part C and D validation auditors and coordinating all communications.
- Assist all departments in review and submission process following Medicare Marketing Guidance for all marketing documents, including review of critical documents, such as ANOC/EOC and Summary of Benefits for Medicare Products and Member handbooks for Medicare-Medicaid plan.
- Ensure federal and state exclusion screening of all organization employees, contracted providers and vendor organizations are being completed on monthly basis.
Sr. Compliance Specialist
EMBLEM HEALTH
05.2009 - 03.2013
- Develop key relationships with internal and external areas to maximize effectiveness of Medicare Compliance Program.
- Coordinate and provide guidance on policies and procedures, identification of compliance issues, trends and risks.
- Develop of process and procedures to ensure regulatory compliance.
- Review and implement Annual Risk Assessment
- Create Emblem Health Medicare Compliance eNet for Emblem Health employees.
- Create and Execute two companywide compliance educational events; Annual EmblemHealth National Ethics and Compliance week and quarterly Compliance Education day.
- Involved in Medicare Compliance Committee (MCC) and Medicare Risk Committee (MRC)
- Review all negotiated pharmacy rebate contracts for accuracy
- Review and resolve accounts receivables discrepancies and follow-up with drug manufacturers for past due payments.
Operations Analyst
VISITING NURSE SERVICES of NEW YORK
01.2007 - 05.2009
- Provide database/department reports and conduct a review of the analysis of issues and implement approved changes
- Direct the Human Resource Administration (HRA) training program to the VNS staff to improve process and delivery, in order to support mandatory business activities
- Develop data collection and reporting tools on programs patient volume, productivity of staff, reimbursement payments from Medicaid and Managed Medicare, performance of the program and budget analysis to meet the analytical needs of the program.
Education
B.S - Health Services Administration
Saint John’s University
Queens, NY06.2007
Certificate -
HCCA Compliance Academy
New York, NY08.2017
Skills
- Policy Compliance
- Contract Management
- Risk Management
- Decision Making & Judgment
- Negotiation
- Department Policies & Procedure Implementation
- Issue Resolution Skills
- Process Management Oversight
- Process Improvement
- Data Analysis
- Training and Development
- Regulatory Compliance
Additional Information
Implemented the new HRA Web-based system for the Long Term Home Healthcare Department of VNS. Assisted in launching a new Medicaid Advantage Plus (MAP) Plan for RiverSpring Health Plans.
Timeline
Assistant Vice President of Compliance
RiverSpring Health Plans
12.2017 - Current
Assistant Director Regulatory Compliance
Elderplan/HomeFirst
04.2013 - 12.2017
Sr. Compliance Specialist
EMBLEM HEALTH
05.2009 - 03.2013
Operations Analyst
VISITING NURSE SERVICES of NEW YORK
01.2007 - 05.2009
B.S - Health Services Administration
Saint John’s University
Certificate -
HCCA Compliance Academy
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