Registered Nurse Medical

DONNA ROONEY, JD, RN, CHC

**** ******** ****** *****, *********, NC 28173

Residence: 704-***-**** . Cellular 954-***-**** . E-mail *********@***.***

SUMMARY OF QUALIFICATIONS

Over 10 years of healthcare compliance and audit investigations /consulting

experience, educating and representing physicians, pharmacists, home health

care agencies and health care providers. Strong healthcare

regulatory/compliance subject matter expert counseling to healthcare

organizations. Primary focus on assessing reimbursement operations and

developing implementation of both technology and lean physician,

healthcare businesses. Team builder and the ability to work collaboratively

with professionals having various backgrounds, including clinicians

(nurses, physicians, pharmacists, billing reps. attorneys. Implement sales

and marketing healthcare compliance programs to meet the needs of a

dynamic, stressed hyper-regulated reimbursement landscape while focusing on

qualitative management of patients' health and outcomes. Excellent

analytical and writing skills, developing client loyalty and strong

business relationships by executing dynamic, energized teaching and

training modules on site to promote client "buy-in" strategies. Travel

extensively to physician and healthcare provider sites to provide "hands

on" approach to oversee implementation of recommendations.

PROFESSIONAL EXPERIENCE

CENTER FOR LEGAL CONSULTING AND LITIGATION, INC. 1999- present

Senior Healthcare Compliance Consultant/ Attorney

. Provide compliance expertise for healthcare providers regarding standards

of conduct, monitoring, documentation, auditing, enforcement, discipline,

response, prevention, BAA's, confidentiality agreements, compliance

intake protocols, provide counsel to healthcare providers with the

necessary safeguards to prevent litigation as well as investigative

expertise in cases involving Stark, AKS, HIPAA, HITECH, including

Medicare Integrity Program (CIA) issues, Medicare Audits involving Coding

(ICD-9-CM, IPPS, MS-DRG's and MDC), DME and allegations of

pharmaceutical billing issues involving "exploding charges", "gang

visits", DME and breaches in assignment agreements, Title XI, Section 28A

audits (CMP law) and OIG cases and disciplinary licensing issues. Provide

planning, designing, implementing and maintaining of organization-wide

compliance programs, policies and procedures.

. Developed key marketing strategies for increasing sales of Healthcare

Compliance Products by 125%. Provide consulting approaches to redesign

operational flow, train staff on managing EMR hardware, software, setting

up EMR committee, to decrease disruption and foster return on investment,

identifying scheduling strategies to improve revenue and patient

satisfaction, recommending payer reimbursement options to improve

provider quality practice management.

. Compliance / Regulatory Consultant: Created and designed innovative

healthcare compliance educational courses involving documentation,

ethics, subject matter expertise, for healthcare professionals and

recruited over 4000 healthcare professionals for participation in IT

critical thinking, anti-fraud programs. MRSA and dangerous pathogens,

OSHA safety policies, procedures, and forms designed specifically for

ambulatory medical facilities.

. Experienced with Dell EMR, powerpoint, excel, Microsoft office, HIT.

. Audit Preparation: Private Payers and CMS: Medicare/Medicaid Billing

Audit Case Experience: Work with physicians and medical groups audited by

the OIG's Office. Extensive monitoring experience in government funded

programs resulting in implementation of a CIA-POA/Compliance.

1986-1999 MEDICAL-LEGAL CONSULTANTS LAW FIRM

ASSOCIATE (JUNIOR) ATTORNEY

. Assisted Sr. Attorneys with research and worked up technical

aspects of medical legal cases, including medical / product

liability as a nurse attorney.

. Conducted expert searches, prepped trial experts, analyzed

medical cases, identified mitigating factors to reduce liability

for physicians, dentists, SNF's and home health care

corporations.

. Successfully negotiated over 200 medical/home healthcare and

pharmaceutical law cases through mediation. Defense team leader,

directing junior attorneys, and handling sensitive client

relationships of medical doctors, pharmacists and healthcare

corporations, including medical malpractice, product liability

cases, criminal (white collar healthcare fraud only), and

administrative law cases for disciplinary licensing boards.

Negotiate and mediate contracts, recovery issues representing

physicians and healthcare organizations.

1984-1986 UNIVERSITY OF MIAMI SCHOOL OF MEDICINE

REGISTERED NURSE /CLINICAL SPECIALIST

. Clinical Specialist- Division of Hepatology

. Clinical Research Assistant- Conducting Clinical Trials/Research

Studies: Pfizer, Glaxosmithkline, Eli

Lilly and Co.

FDA Drug Trials -overseeing quality control and research

integrity/compliance Investigational Drug Experience: Strong

working knowledge of 38 CFR 17.33a and 17.34

1980-1984 BISCAYNE MEDICAL CENTER

CRITICAL CARE NURSE

Critical Care Registered Nurse- Charge Nurse

IV Infusion therapy, PACU, ICU, CCU, Med-Surg, Wound Care Expert

Conducted Research: " Oncological Effects of Chemotherapeutic Drug

Administration on Healthcare

Professionals".

Established and implemented NIH Protocols for the hospital.

EDUCATIONAL / Compliance Training

University of Miami Law School- Juris Doctorate 1986-1989

University of Miami School of Nursing- Master's of Nursing/Pre-Med

(inc./ transfer to law) 1985

Florida International University-Bachelors of Nursing-Summa cum Laude

1984

Center For Medicare and Medicaid Services- Coding and billing anti-

fraud certified

Health Care Compliance Association-"Monitoring and Auditing Practices

for Effective Compliance".

Society of Corporate Compliance and Ethics- "Compliance 101",Compliance

Congress- Webinar Training CIA's "Corporate Transparency

Initiatives, "RAC Audits, Off Label monitoring.

Legal IQ-Compliance 360- "Strengthening Oversight Improvements",

HIPAA/HITECH and Consumer Benchmark Results". Health Care Compliance

Association- Member

Certification - Health Care Compliance - June 11, 2010 Exam HCCA

Licensed: Florida Bar License-FBN 0846170 - Good Standing, Healthcare

Law Section, Federal Court- Southern District, Registered Nurse,

Certified Health Care Compliance-HCCA, Medical Billing and Coding- CPT,

ICD-9, HCPCS, HIPAA- Certified.

"Outstanding Speaker"-International Symposium Oral Surgeons, Boston

University, Keynote Speaker for Hospital Staff Palm Springs Hosp.,

Biscayne Medical Center, FIU School of Nursing, ASLNC, LNC Educational

Center for Healthcare Providers.

. Recent Presentations:

. " Medical Coding E/M : The Medicare Auditing Nightmare"

. "Medical Necessity and Documentation" by D. Rooney

. " Are you RAC Ready" Physician Practice Management by D. Rooney

. How to Improve Revenue Cycles by D. Rooney

. Realistic Scheduling: Doc's..Practice What You Preach!

. Setting up Your Medical Practice in Compliance With the Law

. EMR- Your 2012 Deadline is Just Around The Corner!

. Developing the Lean Machine- Physician Practice Management Issues by D.

Rooney

. "A Call For Leadership" : Broward College: Graduating Nursing Class 12-

14-09

. Phenothiazines and Toxic Epidermal Necrolysis-D. Rooney 5/01/09

. "Ethical Dilemmas Physician Practice Management Billing Approaches" by

D. Rooney[pic]

Contact this candidate