Customer Service Home Health

** ***** ************ **********

Corporate Compliance. Regulatory Affairs. Revenue Cycle Management Reviews

& Analysis.

Accreditation Prep and Survey Readiness. Customer/Physician Relations.

Quality Improvement. Risk Management. HIPAA - Privacy/ Security.

Identity Theft Prevention. PCI - Data Security Standards.

The Compliance Source, LLC

April 27, 2010 to current

. Compliance & Regulatory resource for physician practices and other

healthcare entities as the PPACA initiatives to detect fraud and abuse

are to become mandatory, nationally. Auditor/Monitor all practice

Regulatory Affairs: CMS/AHCA billing, HIPAA, Stark, AKS, OSHA, CLIA,

HCCL, Accreditation prep and more.

. Revenue Cycle reviews and analysis to identify opportunities for

improvement, streamline processes and standardize controls to ensure the

integrity and efficiency of the production of each claim and its accurate

adjudication and collections

. Published in SFL Hospital News and Healthcare Report, "Delusions of an

Industry" - July 2010

. Independent Contractor associated with Beacon Partners and Colaborate

for per diem/contractual work

. Develop and implement audit services to complement the needs of

National healthcare consulting agencies in all Regulatory areas, most

notably ARRA/HiTech Act - Meaningful Use Data, Business Associate

Agreements & Breach Notifications.

. Independent Contractor associated with Source Staffing, LLC a

recruitment and staffing agency for the placement of physicians and mid-

level providers.

. SBA Small business woman-owned buying partner for products, goods and

services for Federal Agencies. Registered Central Contractor.

DUNS # 963447938 CAGE # 632W8

Regulatory Compliance & HIPAA Auditor - Broward Health. 1613 SE 17th St.

Ft. Lauderdale, FL 33316. 954-***-****.

March 31, 2008 - April 26, 2010

. Responsible for the investigation and response to all Federal/State

Regulatory inquiries, including OIG, CMS/AHCA, RAC, OCR complaints;

established a communication strategy for Regulatory Affairs.

. Departmental liaison, auditor and committee manager for the Laboratory

Compliance Program, including audit project management and oversight of

corrective actions and reporting: RFP/Contractor selection, remote and on-

site audit facilitation, corrective action plan development and

monitoring.

. Developed and formalized through documentation, committee and reporting

structure, and process institution, a comprehensive, Privacy and Security

Program, including work plan and audit plan.

. Updated, reviewed and revised 41 HIPAA policies and procedures, including

development of a Breach Investigation and Notification tiered review

process to comply with the new Regulations of 2009 (ARRA/HITECH

Act/Breach Notifications), including update of the Business Associate

Agreement and all training/education initiatives.

. Created a Medical Identity Theft Investigation and Response process to

address the rising number of identity theft allegations reported to the

medical center and in preparation for the June 1, 2010 effective date of

the "Red Flag Rules" of Fair and Accurate Credit Transactions Act of

2003: formalized the Identity Theft Prevention Program and related

policies/procedures, in addition to the initiation of a PCI-DSS

compliance risk assessment for credit card security.

. Established a Privacy & Security Sub-committee, including the development

of its charge, charter and working responsibilities, including a tiered

review of all breaches and HIPAA privacy violations.

. Informally appointed compliance expert within the Department of

Compliance & Ethics; provided guidance to less senior staff in the

department with regard to all compliance risk areas.

Corporate Compliance & Privacy Officer (Director). Sheridan Healthcorp,

Inc. 1613 N. Harrison Parkway, Suite 200. Sunrise, FL 33323 1(800)437-

2672 December 4, 2000 - April 28, 2006

. Developed and implemented a comprehensive corporate compliance program at

a large, national multi-specialty physician group and billing company.

The Company has representation in 14 states, at more than 75 locations

and employs more than 1400. All elements of the OIG Compliance Program

Guidance were satisfied including the ongoing training/education,

auditing/monitoring, investigations/corrective actions, reporting

mechanisms and the establishment of requisite policies/procedures and a

code of conduct.

. Responsible for program budget, work plan development and leadership for

a team of 5.

. Created a "Compliance Extension Program" model to reduce risk of exposure

to fraud and abuse at off-site billing locations.

. Achieved and sustained significant results with respect to increasing

billing and collections in the Anesthesia, Emergency, Neonatology and

Office Based Divisions. Compliance Program initiatives driven by data

tracking, trending and monitoring using quality improvement tools and

techniques.

. Revenue Cycle Reviews and Analyses to identify efficiencies, process

improvements, implement controls and streamline production throughout the

patient care delivery continuum - from provider credentialing and

enrollment thru to patient scheduling, registration, encounter

documentation and coding, billing and collections.

. Office-based division oversight and compliance with FL State HCCL

requirements, OSHA, CLIA and more.

. Implemented controls in high-risk areas and established a formal

reporting relationship with the Board of Directors. Provided leadership,

support and reports to the Compliance & Integrity Committee.

. Directed the successful implementation of the HIPAA Privacy Regulations,

including all related training, policy and procedure generation and

monitoring processes.

. Assisted the General Counsel with the creation of a corporate Risk

Management and Quality Improvement Program.

. An integral member of the "sales team", a group of individuals that

represented the Company to attract new business or potential facility

contracts. Team lead of due diligence audits with respect to the purchase

of physician practices, new facility contracts and acquisitions.

Corporate Compliance Officer. Mount Sinai Medical Center / Miami Heart

Institute. 4300 Alton Road Miami Beach, FL 33140 305-***-**** (Mgr.,

Nov. '98 - Nov. '99/Officer, Nov. '99 - Dec. 2000)

. Responsible for the development, implementation and ongoing

administration of a corporate compliance program in accordance with

the OIG Program Guidance for Hospitals, Laboratories, Home Health

Agencies and Physician practices.

. Compliance Program development included the creation of a code of

ethics as well as all training materials and policies and procedures

in support of the compliance program and execution of all other

auditing/monitoring elements.

. Provided periodic reports to in-house Counsel and the Board of

Trustees regarding Program implementation and status of compliance

with regulatory and institutional policies for all components of the

medical center: hospital, skilled nursing facility, home health

agency, physician practices and laboratory.

. Organizational lead working with outside counsel to negotiate

repayment/demand of the OIG for false claims associated with miscoding

of investigational devices; strategy resulted in more than a 75%

reduction in the monetary repayment. No CIA was demanded, at that

time.

. Advised Board of regulatory changes, areas of liability and corrective

actions.

. Developed and adhered to annual corporate compliance work and audit

plan.

. Facilitated institutional compliance in accord with Medicare Bulletins

and Fiscal Intermediary communications and chargemaster reviews.

. Interacted regularly with senior administration, counsel, regulatory

agencies, physicians and departmental directors.

Director of Regulatory Affairs. Montefiore Medical Center. 111 E. 210th St.

Bronx, New York. 10467 718-***-**** Progressive Leadership

(June 1994 - September 1998)

. Responsible for ensuring compliance with all regulatory and

accreditation requirements, including but not limited to, JCAHO and

NYSDOH.

. Provided leadership for the preparation and process for the first

JCAHO network accreditation survey (accredited with commendation,

November 1997) and tri-ennial survey of all components: hospital,

skilled nursing facility, home health agency, laboratory, ambulatory

care center, physician practices and contract management organization.

. Collaborated with senior executives in the development and

implementation of the Corporate Compliance Program (subsequently

recognized nationally by the General Accounting Office as a model

program).

. Assisted with the establishment of a 200 member preferred provider

organization.

. Developed training materials for providers and their staff.

. Managed and oversaw the activities of 6 provider liaisons for

education, recruitment and retention of over 2000 physicians.

. Principle liaison between all regulatory agencies and the medical

center.

. Particularly active in enhancing the support of patient rights and

customer service initiatives through various modalities and consult

services.

EDUCATION/Certifications:

Master of Arts Degree. Health Advocacy. Sarah Lawrence College. Bronxville,

New York.

Bachelor of Arts Degree. Psychology. Minor: Health Education. University of

Massachusetts. Lowell, Massachusetts.

Certified in Healthcare Compliance. Health Care Compliance Association.

Minneapolis, Minnesota.

Certified Professional Coder (CPC). American Association of Professional

Coders - AAPC.

MEMBERSHIPS:

Health Care Compliance Association (ACTIVE), Association of Certified Fraud

Examiners (ACTIVE), American Association of Professional Coders (ACTIVE),

Society of Corporate Compliance and Ethics (INACTIVE)

Florida Hospital Association - Corporate Compliance (ACTIVE), Greater Fort

Lauderdale Chamber of Commerce (ACTIVE), South Florida Healthcare Network

Group (ACTIVE)

GAP EXPLANATION:

April 29, 2006 - March 30, 2008

Entrepreneur- Owner, Medspa Partners of FL, LLC d/b/a Radiance Medspa of

Fort Lauderdale.

Researched, investigated and purchased a Broward County franchise territory

from Radiance Medspa Franchise Group. Developed business plan, secured bank

financing, site selection/lease negotiations, medical director recruitment,

architectural plans, contractor selection, design and materials selection,

permitting, equipment purchase, product selection, licensure, - the

franchise parent group filed with the IRS a corporate restructuring and

subsequent bankruptcy. Financing was withdrawn before ground-breaking for

the store in the Fall of 2007; project terminated. Alternative fund

sourcing, business plan revision and other business purchases explored

prior to decision to obtain full-time employment with Broward Health.

Contact this candidate