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Compliance, Audit, Legal

Location:
Michigan, United States
Posted:
December 08, 2018

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Resume:

High compliance, solid CORE performing leadership, COMPETENCIES fraud analytical, Attorney/investigation Phone: and Certified and oral/517.audit. BEAU written Public 763.EXECUTIVE 6000 Successfully communication Accountant HILL, Email: SUMMARY Esq.combines udt.with, CPA mil@skills. experience legal gmail.and com leading financial healthcare background with

Legal Research, Analysis & Counsel Contract & Third Party/FDR Oversight

Medicare, Data Fraud Analytics & Abuse Medicaid, & Investigations Report HIPAA Generation Compliance WORK EXPERIENCE Performance Financial, Executive Leadership, Compliance Improvement/Training & Performance Change & Motivation Management Audit EVOLENT HEALTH, Chicago, IL 2018

Senior Design Initiate Evaluate Provide identification CENTENE and Director Program and guidance contractual/CORPORATION, lead implement of healthcare over and $regulatory direction 6 internal million compliance T Integrity roy, to policies, in risks. MI supervised fraud, Align and procedures waste, fraud with staff, and operational investigation resulting abuse and reports. false in practices. for 729% claims Oversee $800 increase recoveries. Review million contract in claims in work annual compliance. data. production revenue. 2017 and Compliance Lead Develop, Institute MERIDIAN • • • • • Medicare/Lead Coordinate Design Develop Organize compliance implement HEALTH compliance Officer and data HIPAA reporting, with execute and analysis, framework PLAN, compliance CMS, staff, reform organizational workflows, Detroit, ZPIC, audit design/compliance for for MAC, and risk MI implement $documentation, 2.monitoring management, RAC, 8 scorecards, billion program CERT policies, in programs. and annual in workflows, policy, training Medicare accordance privacy claims monitoring Design and and and Advantage for corrective with performance forms, compliance 42 federal and offices templates plans. reporting action across and monitoring/standards. state processes. and 12 structure. 2014 regulations. states. standards. training. - 2016 Director Develop/care Research, Advise, • • • • • • • • plans Research Monitor/Assess Provide Hire, Research Analyze Prepare counsel, implement of design, in Regulatory train MI, legal, regulatory and and audit respond state/and IL, reform, and advise deliver IA financial compliance advise claims, supervise and federal Compliance to and compliance departments NH. compliance inquiries regarding and FDR's, execute laws, Evaluate legal, program operational rules, privacy, and & audit, legal delegated recommendations, reports Internal and HIPAA report and for and and General organizational $risks. regulations. 3 to regulatory and billion on services finance Audit corporate Advise legal, compliance Counsel in professionals. agreements. regulatory, corrective annual on Establish compliance, and leadership, on policies coverage program state Medicaid/actions, workflows fraud, and and Revise audit contractors determinations. effectiveness. federal standards. and Medicare/training, and contract compliance and privacy contract metrics. and and templates. Part departments. oversight. reporting. compliance. D matters. managed MICHIGAN HEALTH SERVICES INSPECTOR GENERAL, Lansing, MI 2011- 2013 Inspector Founding Plan/Organize/Design, contract Collaborate Provide Department MICHIGAN • • • • • • • • • • implement Identify Prepare Assemble Review, Develop Advise 244% 300% Fulfillment Suspension reform, and compliance. director reform General LEGISLATIVE with obtain of increase increase leadership Justice negotiate, and and and and a state evidence compliance, overseeing functional of training and/analyze advise advise streamline Supervise 2,National and in in 162 or on cases law approve AUDITOR and on federal on termination data applicable in policies inspector enforcement legally $information audit criminal provide 12 operational initiated; Advocacy attorneys, requests billion law civil/and and compliant GENERAL, enforcement state testimony general's investigation administrative of fraud 120% practices in Center. for 96 clinicians, sharing referrals; practices, annual and state providers investigation administrative increase Lansing, federal office. supporting to agreements and expenditures to elimination investigators, at reduce workflows, achieve settlements. federal national Form with legal in MI cases procedures and $and and fraud 38.fraud, law sanctions with healthcare of completed prevent and 2 Stark/regulatory lead enforcement data million a litigation Testify law compliance 1,13 functional 000 and Anti-analysts, enforcement managed and fraud, in at case conferences reporting, requirements. Kickback, payments and investigative administrative waste and backlog and and work sanctions. care regulators. audit auditors. agencies. and including: and health units. and practices. abuse. objectives. CMS at hearings. plans. U.and S. Assistant Lead Examine Oversee Lead • • • • • • • • • • financial, audits Audit identifying Conduct transactions. Evaluate Examine backlog, Evaluate Review Provide privilege, Advise Lead resulting Examine funding engagements transactions Auditor and two-financial on patient performance, practices. legal and forensic collections and operational Public forensic in state year statutory and felony General/increasing Perform advise counsel white for statements court examining care, reporting Housing reviews financial Identify compliance convictions records on processes. Medicare administration, collar workflows, on Legal and root healthcare monthly Authority Medicare, false of compliance operational compliance, and cause investigations. criminal Counsel access expenditures, with and certification claim investments. identifying output identifying analysis false $compliance, with Medicaid, financial 2.investigation. voir reimbursement EDUCATION 6 audits performance ethics, claims million from legislative dire, to Prepare internal $surveys, 98 identify Review $reporting and housing, 200 1.related lobbying, and million 4 in Housing million investigations. fines/to Coordinate investigative staff controls, pharmaceutical improvement, and contracts 1,findings payments party, 000 privacy, in and and restitution. Tax Joint employment, in additional cases. state/cost counsel. and and Credit and Commission with and false referrals savings, for Supervise conflicts financial federal make reimbursement efficiency FBI allocations controls contracted Testify claims, revenue. Prepare and and recommendations. reducing requirements. to of and taxation. accreditation. professional in attorney-U.law interest and and S. U.draft operational and services. S. Attorney enforcement. rebates. effectiveness. District a payments, legislation. capital 25,violations. client 451 staff. Court.case Juris Bachelor Doctorate, of Arts cum - Accounting, laude Thomas Michigan M. Cooley State University, Law School, East Lansing, Lansing, MI MI



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