Manager Health Care
Resume:
SANDRA L. PIERSOL
Downingtown, PA 19335
610-***-**** (home)
610-***-**** (mobile)
610-***-**** (fax)
********@*******.***
Profile:
A seasoned professional with strong leadership skills highly motivated with
experience in compliance, process improvement, people development,
operations and sales. An outstanding project leader and coach,
consistently involving team members in decision making. Senior Executive
with a successful history in developing leadership skills focusing on
regulatory compliance, litigation support, physician organizations, and
academic medical centers. Proven capabilities in the following areas:
Health Care Fraud and Abuse Financial Management
Regulatory Compliance for Operations of healthcare entities
Providers
Regulatory Risk Due Diligence Sales and Marketing
Physician Coding and Billing Investigations and Negotiations of
Compliance Health Care Entities
Revenue Cycle and Reimbursement Training and Education
Corporate Integrity Agreements Superior Client management skills;
DME operations and billing proficient in managing/adapting to
compliance evolving client expectations and
ensuring client satisfaction
Professional Experience:
Catholic Health East January 2010 - September 2010
Director, Corporate Compliance
Key responsibilities include managing processes to maintain an effective
compliance program, serving as a resource for each of the regional health
corporation's compliance officers and developing and monitoring the
implementation of compliance-related policies, practices and procedures for
Catholic Health East and the Catholic Health East system office.
Accomplishments:
. Conducted compliance orientation for new colleague orientation.
. Participated in revising the Code of Conduct.
. Analyzed and reported findings of quarterly reports from regional
health corporations to Risk Assessment and Monitoring Council and
Senior Management Team of the organization.
. Participated in a process improvement work group to improve the
utilization management process, billing, and coding and compliance
process for care management.
. Assisted in implementing several compliance tools to trend and track
compliance related activities.
. Participated in the system wide work group to ensure the
organization is meeting "meaningful use" on designated timelines.
. Coordinated HITECH Privacy work group meetings to assist the
organization in complying with HITECH regulations.
Navigant Consulting, Inc 2004- 2010
Director
Healthcare Disputes, Compliance and Investigation Practice
Key responsibilities include business development, tracking industry
trends, client relationship management, staff development, project
direction and delivery.
Accomplishments:
. Assisted large device manufacturer with a compliance review, process
improvement of their billing system and internal investigation of
their billing process.
. Led an engagement where a team of professionals reviewed physician
contracts prior to the merger of three hospitals into a large health
system.
. Project Director for clinical trials/research project at a large
academic medical center testing internal controls for clinical trials
billing compliance.
. Led an engagement for a large academic medical center providing due
diligence services for physician practices where the team analyzed the
operations of the practice and their coding compliance.
. Responsible for several engagements for Independent Review
Organization ("IRO") services for our clients.
. Led a team of professionals performing a compliance risk assessment
for the physician network.
. Served as Project director where the team performed annual compliance
reviews for an orthopedic device manufacturer.
. Performed due diligence services for several clients to asses their
compliance risk prior to purchase.
. Led teams of consultants assisting largest dialysis company in the
United States with compliance related engagements, as well as, mock
IRO services and due diligence projects.
. Assisted large academic medical center with several engagements
related to drug diversion, clinical trials compliance and physician
training.
. Provided leadership on engagements in the firm's Compliance and Risk
Mitigation practice.
. Responsible for several opportunities to cross-sell services for the
firm's valuation services.
. Became a trusted advisor for several large clients and law firms in
the healthcare industry.
Deloitte & Touche, LLP 2001 - 2004
Senior Manager
Health Care and Life Sciences Regulatory Practice
Key responsibilities include business development, client relationship
management, project direction and delivery.
Accomplishments:
. Grew the local practice from $10 thousand to $1 million in sales revenue
. Develop marketing materials for national Health Care and Life Science
practice
. Assist with marketing and networking at all major Health Care seminars
and marketing cross-functionally with in the firm.
. Manage several IRO engagements for large academic medical centers,
physician billing companies, hospital systems and mental health agencies
. Perform comprehensive regulatory risk due diligence engagements for
various health care entities
. Assist a Durable Medical Equipment (DME) company which was an affiliate
of a Children's Hospital with a self-disclosure of overpayments to the
Regional DMERC.
Ernst & Young, LLP 1994- 2000
Senior Manager
Health Care Litigation Advisory Services
Starting at the Senior Consultant level and receiving accelerated
advancements to Manager, and Senior Manager during a six year employment
history. Lead consultant responsible for developing and growing the
National Health Care Litigation support service practice group.
Accomplishments:
. Assisted the nation's largest physician group specializing in maternal-
fetal-newborn care through governmental investigation into alleged
Medicaid fraudulent billing of neonatal services and subsequent
settlement process to favorable outcomes.
. Conducted large engagements where the client is under a government
investigation for billing and coding compliance
. Assisted clients with their Corporate Integrity Agreements (CIA) and
developing the role of the Independent Review Organization (IRO)
. Provided academic medical institutions support who are undergoing a PATH
I or PATH II investigation
. Served as the key team member for many of the firm's large health care
litigation support engagements
. Assisted clients with process improvement business office redesign and
physician practice valuations.
Key Competencies:
. Engagement management and client budgets, billing and collections from
clients and medical record reviews with extrapolation of results
including error rates.
. Recruiting of new staff, training new staff, counseling staff on career
goals and performance management and feedback.
. Physician billing office assessments and operational reviews of physician
practices using benchmark data.
. Part B physician coding and reimbursement, CPT and ICD-9 coding including
evaluation and management services, CIA/IRO reporting to the OIG and OIG
self-disclosure protocol.
. Responsible for annual personal and group sales goals.
Pottstown Surgical Associates, Ltd. 1991 -
1994
Business Manager
. Financial: Accounts Payable, Accounts Receivables, Third Party
Reimbursement
. Contracting: Negotiating with insurance companies, worker's compensation
employers or carriers
. Human Resources: Supervise and coordinate all practice staff, recruitment
including physicians
. Reporting: Month end revenue reports, Productivity reports, Profit and
Loss statements
Other employers:
WeightWorks - a start-up weight loss center affiliated with a local Medical
Center.
Center Manager
Abbey/Foster Medical- a National Durable Medical Equipment ("DME") company
Branch Operations Manager
Education: Slippery Rock State College, Slippery Rock, PA
BS - Health Sciences/Public Health
Professional Affiliations:
Health Care Compliance Association
American Health Lawyers Association
Women's Business Leaders of the Health Care Industry
Board of Trustees, Greater Philadelphia Chapter of ALS
Board of Directors, Greater Philadelphia Chapter of ALS
Board of Directors, Community Health Charities,
Pennsylvania
Publications
. Healthcare Compliance on a Shoestring, Compliance Today,
HealthCare Compliance Association, June 2010
. Guide to Resident Compliance Training, Health Care
Compliance Association, June 2004
Speeches and Presentations:
. November 2010, Seton Hall Law School, Key Compliance
Issues Facing Directors and Trustees of Health Care and
Life Science Companies.
. July 2009, Pennsylvania Bar Institute, Understanding the
Basics of Fraud and Abuse in the Health Care Industry.
. April, 2009, Directors Roundtable, New York, NY, Key
Compliance Issues Facing Directors and Trustees of
Health Care and Life Science Companies.
. March 2009, Pennsylvania Bar Institute 15th Annual
Health Law Institute, Consulting Opinions in the Health
Care Arena.
. April 2007, Health Care Compliance Association Annual
Compliance Institute, Picking Up the Pieces- Re-
Designing Your Compliance Plan from Head to Toe.
. December 2006, Navigant Consulting's Northeast Women's
event, keynote speaker, Take A Break (for you Re-
Energizing Your Mind & Body
. October 2004, 2005, 2006, Jones Day/Navigant
Consulting's Compliance Forum, faculty member
. September 2003, Deloitte & Touche's College for Health
Care & Life Sciences, The Regulatory Environment for
Life Sciences & Current pressing Clinical Regulatory
Issues, Orlando, FLA.
. September 2003; American Health Lawyers, Health Care
Compliance Association Fraud and Compliance Forum, Best
Practices and Their Application to Compliance Program
Auditing and Monitoring Plans. Washington, D.C.
. April 2002; Health Care Compliance Association 2002
Annual Compliance Institute, Sampling Techniques for
Auditing and Monitoring, Chicago, Illinois.
. March 2002; the Second Annual Medical Research Summit,
Billing and Research: A Practical Approach Towards
Compliance, Washington, D.C.
. June and July 2001, American Health Information
Association (AHIMA) Summer Coding Series, Modifiers and
Medical Necessity, Nashville, Tennessee and Anaheim,
California.
. October 2000; Health Care Billing and Management
Association Annual Meeting, Compliance for Physicians,
Newport Beach, California.
. October 1999; Health Care Compliance Association 1999
Compliance Institute, Auditing for Physician Compliance,
Chicago, Illinois.
. May 1999; Florida Chapter of HFMA, Self-Review of
Billing Compliance, Clearwater, Florida.
. April 1999; New Jersey Hospital Association and New
Jersey Chapter of HFMA, Physician Coding Documentation
and Compliance, Princeton, New Jersey.
. May 1998; Medical Group Management Association (MGMA)
Anesthesia Administration Assembly, HCFA/AMA
Documentation Guidelines for Evaluation and Management
Services, Denver, Colorado.
. September 1997; The Hospital and Health Association of
Pennsylvania Education Services, Corporate Compliance
Programs for Health Care Organizations, King of Prussia,
Pennsylvania, Harrisburg, Pennsylvania and Pittsburgh,
Pennsylvania.
. September 1997; Philadelphia Chapter of HFMA, Tools
Needed to Function in a Compliance Environment-Systems
Controls, Philadelphia, Pennsylvania.
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