Betty Alba C: 201-***-**** Email: ad4vq9@r.postjobfree.com

PROFESSIONAL SUMMARY

Accomplished audit, compliance, finance, and accounting, professional with progressive roles in healthcare with over 25 years of experience and proven results in directing and managing internal audit departments, including Telecom regulatory compliance activities for multi-billion-dollar health systems and organizations. A highly regarded, action-oriented, recognized for effectively performing risk-based internal and external audits, leveraging data driven analytics, identifying risks, assess controls, root cause-effect analysis relationships; ability to deliver in an agile innovative approach, support in the development of business focused plans of correction to effectuate positive change, resulting in process improvements, operational efficiency, strengthening internal controls, added value, enhance compliance, and realize profitability. Key areas of expertise include:

Directed/managed internal audit functions including supporting the Audit & VPP Compliance Program.

Designed, developed, and implemented the 1st Corporate System Wide Risk Assessment methodology for an integrated healthcare delivery system.

Generated substantial financial, operational, administrative, and organizational impact through multiple focused value-added audits.

Identified enhancements for business operations, financial, clinical, revenue, and compliance processes resulting in value added and positive impact.

Implemented agile, risk-based process, revenue risk and control assessments level auditing.

Initiated a continuous monitoring and auditing process through advanced data analytics for real-time monitoring and benchmarking.

PROFESSIONAL EXPERIENCE

New York Presbyterian Hospital (NYPH) System – New York, NY 5/2017 – Current

Manager – Internal Audit and Compliance

Reporting to CAE/VP and Director on Internal Audits and Compliance related engagements. Manage and supervise concurrent audit engagements, perform ongoing risk assessment, initiate, and maintain key stakeholders’ relationships, process owners, consulting projects and special assignments, identify key risks, controls and gaps, processes improvements, while mentoring and coaching team. Responsibilities Include:

Manage, execute, and support part of the Internal Audit Department’s Audit Plan.

Support in the preparation and presentation of Internal Audit results to Senior Leadership and key stakeholders, at the local campus level quarterly meetings.

Responsible for the development and maintenance of key stakeholders’ relationship program to collaborate, partner, be a business advisor and provide guidance.

Manage all aspects of audits from planning, budget, development of risk control matrix (RCM), audit approach/program and conducting concurrent audit engagements, including operational, financial, compliance, process improvements, integrated reviews, consulting engagement and special request with significant impact in operations, policy and regulatory compliance, business, and organizational outcomes.

Identify potential risk areas within each engagement, review controls to mitigate risks, better manage audit resources, identify root cause and opportunities for improvements resulting in valued added, including revenue cycle, charge master, pharmacy, AR, clinical trials, physician compensations, expense reports, construction, health plans, and regulatory compliance.

Manage and direct a group of auditors to identify risk, assess operational controls around processes and prepare reports for various departments across the New York-Presbyterian Hospital Network.

Responsible for the day-to-day project management, including managing budgets, milestones, and staff, planning and managing assignments, reviewing, and approving approach for testing on all engagements, risk assessments and special projects.

Perform comprehensive reviews of automated workpapers for the audit engagements utilizing the Quality Assurance Assessment (QAR) checklist and templates.

Responsible for the development of Audit Reports, observations and collaborate with stakeholders on Plans of Correction (POC).

Responsible for the Tracking/monitoring/testing for validating plans of correction through closure.

Perform on-going risk assessments and annual risk assessments.

Develop and coach team members.

Assist in the recruiting, onboarding, and training process of internal audit professionals, including Interns.

ACTA Consulting – Compliance, RA, Assurance & Audit Consultant Basking Ridge, NJ 9/2015 – 4/2017

Verizon Partner Program (VPP) Business Market – Compliance Program

Reporting to Senior Management and Legal on all the Compliance and Assurance Program governance activities, managing compliance and audit engagement, conducting discussions with business partners, management of compliance projects and special assignments, identify key risks, processes and controls, coach on both external & internal standards, P&Ps, and best practices implementation. Accomplishments Included:

Contributed to the design, development and implementation of a compliance framework and function, including auditing and continuous monitoring activities, crafting a compliance manual guiding the VPP program compliance standards and procedures, including operational and audit activities requirements.

Supported and managed part of the compliance audit plan.

Collaborated on crafting compliance and strategies to reflect the philosophy and goals of the VZ organization’s CREDO mission statement.

Supported and collaborated in the Compliance Program related activities, including performing regulatory compliance audits activities, monitoring, and reporting on leads compliance, Onboarding, and training of VPP Agents, among other regulatory activities.

Contributed to the development of a compliance manual, creating M&Ps for guidance, auditing, and monitoring activities.

Collaborated, assisted, and guided the VPP Partners in driving the compliance elements necessities, operational improvements and enhancements identified in the audits.

Responsible for all aspects of audits, planning, development, directing, managing, and conducting and reporting, including compliance, operational process improvements, special request projects audits with significant impact in administrative, business, and organizational outcomes for VZ North America Region.

Participated in weekly compliance meetings impacting the VPP program.

Partner and assisted on quarterly compliance audit activities, guided, and trained on function’s M&P.

Served as a resource to VPP Partners for compliance to drive transparency.

CarePoint Health Management Organization, Hudson County, NJ 1/2012 – 8/2015

Head of Internal Audit – Compliance and Internal Audit Department

Reporting to the VP of Compliance and Internal Audit, and the Board of Directors Audit and Compliance Committee for audit department’s activities of a multi-million-dollar healthcare system. Accomplishments Included:

Directed, managed, and administered Bayonne Medical Center’s Audit Department.

Designed, developed, and implemented the 1st Corporate System Wide Risk Assessment methodology for an integrated system, which included three Hospitals, Physicians' Medical Groups, Physicians’ Private Practices, Joint Ventures, a Health Plan, a Durable Medical Equipment ‘DME’ and Ambulance Services, for the purpose of identifying high risk areas for the annual compliance and audit plan.

Implemented an audit approach to include clinical audits with financial, process level, operational and forensic audits to effectuate major revenue, financial and operational enhancements.

Implemented an audit approach to ensure the quality and scope of the audit complied with CMS regulations, the AICPA, Institute of Internal Audit, GAAP, GAAP, COSO, FASB pronouncements and guidelines, and External Audit standards.

Collaborated with VP on crafting audit and compliance strategies to enable the compliance and audit department to reflect the philosophy and goals of the organization’s mission statement.

Implemented a risk-based process assessment level auditing approach to identify, prioritize, and evaluate the risks in workflow that impacted the area to be audited.

Incorporated innovative audit techniques and state-of-the-art technology to deliver value-added, services, resulting in over $350,000 identification of fictitious invoicing and cost reduction.

Conducted Health Plan Medicare Advantage ‘Part C & D’ and other cross-functional areas regulatory compliance audits, monitoring adherence to CMS, Federal and State regulatory requirements.

Initiated an institutional wide reconciliation charged capture process, collaborated with consultants and business process owners/stakeholders to develop, implement, validate, and initiate reconciliation reporting procedures resulting in revenue enhancements in numerous clinical areas.

Responsible for all aspects of audits planning, development, directing, managing, and conducting audits.

Participated in monthly compliance and internal audit committees’ meetings.

Westchester Medical Center, Valhalla, NY 9/2009 – 12/2011

Audit Specialist - Internal Audit Department

Reported and collaborated with the VP of Internal Audit for audit department’s activities, participated in Board of Directors Audit and Compliance Committee meetings of a multi-million-dollar healthcare system that included a trauma center, children’s hospital, physician faculty practices and numerous clinical practices. Accomplishments Included:

Developed and performed organizational-wide RA methodology process for the audit plan.

Collaborated with VP with the planning and execution of the annual audit plan. Participated in compliance and audit committee board meetings and presentations.

Worked in synergy with Corporate Compliance Office on regulatory compliance audits and projects.

Engaged with business unit management/leaders and various control partners to identify and assess risks and controls for risk-based approach audit process.

Managed and performed financial and operational process audits. Responsible of identifying opportunities for improvements which resulted in business unit operational changes and valued-added services and revenue enhancements.

Evaluated GAAP, COSO, FASB, THEIIA standards & guidelines, compliance with GAO & State Statutes in all audits performed.

Collaborated, participated, and provided guidance in the performance of year-end audits with External auditors and supporting the financial regulatory reporting.

Responsible for all aspects of financial, operational audits audit processes, including planning, initiation, development, execution, and report presentation phases. Identified numerous regulatory non-compliance issues, which resulted in compliance initiatives process improvements, revenue enhancements, and cost reductions.

Identified many clinical, financial, internal controls and operational deficiencies, which contributed to management changes, financial and operational process improvements, revenues enhancements, asset safeguard and control, establishment of new P&Ps.

Contributed to the establishment of validation controls, verification, reconciliation procedures, charge capture and additional revenues realized.

Montefiore Medical Center, Bronx, NY 1/1993 – 8/2009

Audit Manager - Department of Audit Services (Progressive Levels)

Reported and collaborated with the VP of Internal Audit for audit department’s activities, participated in Compliance and Audit Committee of the Board of Trustees, $2.6 billion, integrated healthcare system, over 2,000 employed physicians, Ambulatory Care Networks, Medical Groups, and faculty practices. Worked with forensic investigator on special projects, supervised and trained staff members, participated and assisted external auditors. Accomplishments Included:

Assisted Department V.P. with the annual audit plan, performed senior management grand rounds interviews/surveys. Performed audits in areas associated with institution Finance, Compliance, Human Resource, regulatory and Information Technology.

Participated in audit committee board meetings, audit presentations, management projects, department representatives and ensure internal controls were addressed to safeguard hospital assets, including development of continuous auditing and monitoring methodology through “CAATs”.

Managed and executed many audits, including clinical, operational, financial services, compliance activities, clinical, and business areas, identifying high risk areas, operational efficiencies, process break down, and contributed to millions in revenue opportunities, potential saving, and identification of process improvements resulting in major valued-added services. Ensured timely reporting and resolution through corrective actions, management initiatives, and follow-ups.

Credited for the identification of over $800,000 in salary, OT and shift differential payments of clinical staff, leading to prosecution, in collaboration with Bronx’s DA’s Office. Managed, performed and supported numerous forensic investigations, including preventive, detective and corrective controls for cost reductions.

Managed, supervised, reviewed, collaborated, and trained audit staff in audit assignments. Performed appraisals reviews and staff development.

Redesigned manual workflows resulting in implementation of automated procedures for revenue cycles.

Executed many financial, business operational and clinical process audits, forensic audits, surveillance identifying revenue opportunities (Registration, scheduling, verification, coding and denial management, sanction audits of employees, employee benefits and vendors and monitoring of systems’ edits for technical and professional components, rejections and payment denials, employee and patient privacy compliance research, clinical trials and identify potential areas of improvements.

Responsible for supporting the data analytics for audit projects, assessment of internal controls, ensure the safeguarding of assets, employee and patient privacy and improvement. Developed recommendations in a collaborative approach for management action plans.

Worked in synergy with Corporate Compliance Office on special projects.

Assisted in the conversion and implementation of manual labor-intensive processes to computerized automated procedures resulting in efficiencies, process improvement and reduction of manual errors.

Supported external auditors with year-end projects (A-133, AR, Accounts Write-Offs, policy compliance, analytics, Grants, Work-papers reviews and other projects, fieldwork and data gathering).

EDUCATION - B.S. Accounting Certified Notary Public - New York State

Herbert H. Lehman College, Bronx, New York

Concentration in Computer Science

PROFESSIONAL DEVELOPMENT/AFFILIATIONS

CIA Candidate (Candidate)

Certified Fraud Examiner ‘CFE’ (Candidate)

Certified Healthcare Compliance (Candidate)

Institute if Internal Auditors (IIA)

Health Care Compliance Association ‘HCCA’

Healthcare Financial management Association

Medical Terminology & Coding training CPT, ICD-10

Certificates in Audit Command Language ‘ACL’ through Advanced Level

Association of Healthcare Internal Auditors (AHIA)

Association of Certified Fraud Examiners (ACFE)

NYS Notary Public Association

PRESENTATIONS

Monthly & Quarterly presentations to Presidents/Executives Audit Plan, Engagements & Plan of Corrections (POCs)

Quarterly key stakeholders’ relationship program ongoing risk assessments, presentation of audit plan, engagement status

VZ Compliance manual presentation, Master Program guidance, National webcast meetings

Presentation on Revenue Cycle Audit at AHIA former Healthcare Audit Network (HAN) National Conference

Corporate Compliance Program presenter (CarePoint Health and Montefiore Med Center)

Corporate Compliance presenter, Physicians & EMTALA Orientation (CarePoint Health)

SOFT SKILLS

Critical thinking, problem-solving, skilled multi-tasker, organizational skills, and attention to details.

Exceptional time management and organizational skills.

Leadership, embraces change, collaborates, team building, and active listening.

Foster a culture of openness, teamwork, positive work environment, integrity and provide directions.

Reliable, innovative thinker, adaptable, flexible, and productive.

Knowledge of the reimbursement processes for hospital and physician services.

Knowledge of the Charge Description Master (CDM) process and the validation of CPT/HCPCS Codes.

Strong understanding of medical terminology.

Ability to thrive in a dynamic, fast-paced environment and manage multiple projects simultaneously.

Excellent interpersonal, written, and oral communication skills.

COMPUTER & SOFTWARE SKILLS :

EPIC, AllScript, Electronic Medical Records(EMR), ServiceNow, SalesForce, SharePoint, ACL, Billing & Claims (Meditech, Epic, ePremis, Phamis Lastword, IDX, Eagle), MS Suite (Excel, Word, PowerPoint, Access), MS Teams, OneDrive, Lotus Notes, Audit Assist & GRC Tool, Teammate, Process flows (Smartdraw, Visio and AllClear), Video/Web Conferencing Zoom, Instant Messaging, WebEx, MediRegs, ComplySource, Financial Management (SAP Business & Payroll, Lawson, CareCast, Kronos Workforce, Siemen’s Pathways, Siemen’s, Financial Ledgers System)

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