TERENCE C. CHRISTOPHER
Atlanta, GA 30349 Email: email@example.com COMPLIANCE EXECUTIVE
Accomplished, goal-driven professional with a comprehensive background encompassing the areas of program management and regulatory compliance. Strong leadership abilities, with proven expertise in developing and managing strategic programs; leading cross-functional teams; and directing a broad range of departments and projects. Highly knowledgeable in state and federal legislative and regulatory processes. Career track record of successful accomplishments, including managing a Compliance program and creating a compliance committee. AREAS OF EXPERTISE
UNITEDHEALTHCARE COMMUNITY PLAN, RIDGELAND, MS 2013 – PRESENT COMPLIANCE OFFICER
Manage and implement the Compliance Program and the UHG Code of Conduct, respectively
Ensure that plans maintain compliance with applicable policies and procedures.
Facilitate the annual review of procedures and oversee state or training requirements.
Develop and implement monitoring and auditing procedures to determine compliance with requirements.
Partner with operational leads on training programs pertaining to federal, state and local standards.
Coordinate with various agencies to conduct investigations and implement corrective actions.
Collaboratively assess regulatory contract requirements, including all state and federal regulatory contracts, amendments and mandates.
Coordinate privacy-related activities to ensure effective training. Key Accomplishments:
Created a Compliance Committee solely for administration of the Compliance Program. UNITEDHEALTHCARE, BEHAVIORAL HEALTH, OPTUM, ATLANTA, GA 2007 – 2013 REGIONAL DIRECTOR, CLINICAL COMPLIANCE
Serve as a subject matter expert for new and proposed legislation and regulation for assigned jurisdictions.
Develop and maintain an organizational structure for compliance, operational standards and policies.
Coordinate audits and assist with Sarbanes Oxley and SAS-70 General Computing Control compliance.
Manage direct reports in a matrixed compliance organization by setting goals and performance expectations.
Provide consultative expertise and promote compliance with applicable laws and regulations.
Develop regulatory relationships and consistently interact with regulatory agencies.
Identify issues for resolution and partner with compliance functional areas to resolve issues.
Provide technical oversight for market conduct exams and other regulatory reviews. Key Accomplishments:
Lead the Ethics and Integrity Program; utilized strategies to publicize the reporting system.
Managed the HIPAA Compliance Program, which includes Privacy, Security and compliance initiatives. HORIZON BLUE CROSS & BLUE SHIELD, NEWARK. NJ 2005 – 2007 MANAGER, SERVICE COMPLIANCE OPERATIONS
Managed a multitude of compliance activities, including policy development and implementation.
Provided direction to staff, service operations programs and administrative activities.
Ensured division compliance with Sarbanes-Oxley implementation, including policy development.
Prepared and presented root cause analysis reports to the Quality Improvement Committee.
Terrence C. Christopher Resume, Page 2
HORIZON BLUE CROSS & BLUE SHIELD, NEWARK. NJ (CONTINUED) 2005 – 2007 MANAGER, SERVICE COMPLIANCE OPERATIONS
Functioned as Chair of the Benefit Appeals Committee.
Designed and implemented project management activities associated with assigned projects.
Supervised the appeals team in the preparation and delivery of benefit appeals decisions.
Maintained consistent process workflow and content to implement mandates and pending regulations. AMERICHOICE, NEWARK, NJ 2001 – 2005
MANAGER, CONTRACT ADMINISTRATION OFFICE OF GOVERNMENT AFFAIRS (2003 – 2005)
Collaborated with government officials to promote AmeriChoice’s business goals and objectives.
Researched, monitored and analyzed state contracts, amendments, legislation and health policy initiatives.
Provided operational guidance to business partners pertaining to state Medicaid requirements.
Interfaced directly with State and Federal regulators to resolve issues affecting members’ access to service. Key Accomplishments:
Developed and directed educational campaigns to assist members of Congress and state legislatures in recognizing issues pertaining to the health care industry and specific issues effecting AmeriChoice.
Prepared commentaries and summaries to support change initiatives that may impact AmeriChoice business.
Communicated programs to facilitate internal awareness of federal and state legislation affecting operations. BEHAVIORAL HEALTH CARE MANAGER (2001 – 2003)
Oversaw all utilization management activities pertaining to the behavioral health care of plan members.
Reviewed all individual adverse event reports for clinical and regulatory assessment statewide.
Served as an authority on company contract health plan initiatives as well as legislative, regulatory, administrative, and political processes affecting the initiatives. EDUCATION & TRAINING
Continuing EducationWoodrow Wilson School of Public Policy and International Affairs, Princeton University, NJ Health Law and Policy, Seton Hall University School of Law, Newark, NJ Social Policy and Planning, Rutgers University, New Brunswick, NJ Journalism, Rutgers University, New Brunswick, NJ