Privacy Specialist/Auditor

Rosie Reyes, CHC

An exceptionally well-organized, dedicated, and proficient compliance

health care professional with strong analytical and problem solving skills,

makes well thought-out decisions, and meets deadline commitments with

professional accuracy and discretion. Strong interpersonal skills and

works effectively with all levels of staff to build good working

relationships. Detail-oriented, resourceful, excellent written and oral

communication skills with the ability to effectively multitask in a fast

paced high pressure environment while managing multiple projects/audits and

priorities simultaneously.

Excellent technical proficiency using Microsoft Word, Excel, Power Point,

Visio, and several proprietary databases and applications and the ability

to quickly master new skills and software applications.

Fluent in English and Spanish . Over 21 years of healthcare experience .

Over 14 years of management experience

~PROFESSIONAL EXPERIENCE~

CHILDREN'S MEDICAL CENTER, Dallas, Texas

Compliance and Internal Audit, Privacy Specialist/Auditor, April 23, 2012 -

present

Perform operational audits to monitor compliance with federal and

state privacy laws and Children's privacy policies and procedures in

collaboration with the Privacy Officer/Manager.

Prepare reports, related analyses, and make recommendations to Privacy

Officer/Manager to ensure privacy compliance and improve internal

controls.

. Recommend appropriate follow-up actions related to patient privacy

complaints/incidents, etc. Utilize results of incidents to monitor

programs and remediation plans. In collaboration with the Privacy

Officer/Manager conduct investigations and/or audits related to

privacy.

BAYLOR HEALTH CARE SYSTEM, Dallas, Texas

Revenue Cycle Regulatory Compliance Senior Consultant, July 2006 - April

13, 2012

. Develop, implement, and monitor revenue cycle compliance policies and

procedures to ensure compliance with all state and federal

regulations.

. Execute revenue cycle compliance solutions across the BHCS revenue

cycle to ensure compliance and consistency.

. Coordinates revenue cycle compliance activities between BHCS Corporate

departments and facilities.

. Facilitate interdisciplinary activities including but not limited to

audits, reviews, investigations, workflow redesigns, and policies and

procedures.

. Analyze and identify revenue cycle compliance risk and trends.

. Facilitate compliance communication across the BHCS revenue cycle

including but not limited to the development of on-site training

materials, presentations, web based educational activities, and policy

and procedure implementations.

. Thoroughly perform and execute investigations and effectively

communicate any compliance risks to management, customer, and legal.

. Complete executive reports outlining compliance risks and trends.

. Extensive experience with clinical research billing auditing and

monitoring, and regulations for obtaining informed consent.

. Monitor and maintain a high degree of current knowledge of revenue

cycle compliance state and federal regulations for all payers.

. Maintain knowledge of applicable federal and state privacy laws to

respond appropriately to privacy inquiries from BHCS Corporate

departments and facilities.

Rosie Reyes, Page 2

BAYLOR HEALTH CARE SYSTEM, Dallas, Texas

Revenue Cycle Improvement Consultant, July 2004 - July 2006

. Assisted revenue cycle departments which included but not limited to

Patient Access Services, Centralized Business Services, and the

clinical departments, in the analytical components of workflow

redesign.

. Assessed, analyzed, planned, trained, and implemented key revenue

cycle operations.

. Identified revenue cycle inefficiencies by researching, analyzing

data, and creating solution alternatives.

. Developed and implemented on site training sessions for BHCS revenue

cycle staff.

. Lead and participated in a variety of initiatives designed to improve

services, streamline processes, improve quality, and increase the

financial strength of the organization.

. Completed high level professional reports outlining compliance risks

and trends

. Identified potential risk exposures and objectively evaluated the

effectiveness of internal controls surrounding the activities of all

departments and entities.

. Planned, directed, and coordinated activities of projects to ensure

that goals and objectives of the projects were accomplished within a

determined time frame.

. Maintained project plans, schedules and issues lists.

BAYLOR UNIVERSITY MEDICAL CENTER AT DALLAS, Dallas, Texas

Medical Necessity Manager, July 2002 - July 2004

. Implemented Medicare Medical Necessity Screening and ABN in Patient

Access Services.

. Responsible for audits, workflow redesigns of processes, and developed

policies and procedures.

. Developed and executed departmental objectives, policies, and

procedures.

. Assisted in the assessment and management of business and risk, made

recommendations on improving internal controls and provided bottom-

line oriented solutions.

. Developed and implemented education training tools for medical

necessity screening and ABNs.

. Responsible for the pre-registration staff in Access Services.

. Trained and educated Baylor Senior Health Centers on the HIPAA

authorization and Notice of Privacy Practices requirements.

. Served as a privacy liaison for the registration staff at Baylor

Senior Health Centers.

. Extensive knowledge of applicable federal and state privacy laws.

U.S. ONCOLOGY, INC., Dallas, Texas, March 1999 - July 2002

Texas Diagnostic Imaging Center Business Office Supervisor

Sammons Cancer Center Business Office Supervisor

Central Business Office Accounts Receivable and Billing Supervisor

. Supervised a staff of up to 20 FTEs

. Responsible for planning, organizing, directing, and controlling the

activities of personnel that include, registration, precertification,

insurance verification, collections, billing, customer service,

financial counseling, and scheduling.

. Performance monitoring, process design and policy development.

. Prepared financial and administrative reports.

. Responsible for interviewing, hiring, firing and training of

personnel.

. Daily management of, billings, collections, reconciliation, general

ledger, aging and month-end-closings.

. Research, review, and approve refunds.

. Ensure systems integrity of mainframes through proper operations and

troubleshooting.

. High degree of knowledge of billing and insurance requirements for all

payors.

. Maintained knowledge of applicable federal and state privacy laws.

CLINICAL NEUROSCIENCE, P.A.

Medical Office Manager, March 1992 - November 1998

. Managed a staff of up to 10 FTEs

. Coordinate all activities of a multi-physician office to ensure

efficient office operations that include registration,

precertification, insurance verification, collections, billing,

customer service, financial counseling, and scheduling.

. Develops and monitors operating and capital budgets.

. Managed all aspects of billing, A/R and A/P general ledger postings,

and payroll processing.

. Responsible for interviewing, hiring, firing and training of

personnel.

. Assisting in the development of annual budgets and monthly financial

statements.

Rosie Reyes, Page 3

. Assisting in the preparation of annual audits.

. Medical staff credentialing requirements

. Managed and monitored quality assurance and risk management

initiatives.

. Developed and implemented privacy, use and disclosure of PHI, and

medical records policies and procedures.

. Extensive knowledge of applicable federal and state privacy laws

NATIONAL DATA CORPORATION, Dallas, Texas

Voice Service Operations Supervisor Level I, September 1988 - August 1991

. Supervised a staff of up to 25 FTEs

FRANCISCO S. MEDINA, D.O., Dallas, Texas

Medical Assistant/Receptionist, June 1986 - 1988

~EDUCATION~

Cedar Valley College, Lancaster, Texas

1988-1991 Red Oak High School, Red Oak, Texas

1984-1988

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