KIMBERLY L. JEFFERSON

***** ****** ***** **** ● Wesley Chapel, Florida 33544

Telephone: 850-***-**** ● Email: acb7xs@r.postjobfree.com

HEALTHCARE COMPLIANCE ●ADULT EDUCATION ●NOT-FOR-PROFITS

PROFILE

Offering more than ten years professional experience with a comprehensive background in state and

federal government and not-for-profit organizations. Practice exists in healthcare compliance

management, oversight and development, healthcare privacy, Florida Medicaid, online adult education,

undergraduate course design, monitoring and auditing, quality assurance and training.

Strong communication and presentation skills with the ability to thoroughly research, analyze, manage,

propose creative solutions and bring projects to completion under demanding deadlines.

Extremely organized with the ability to pay close attention to detail.

Qualification Highlights:

Compliance Program Readiness Review Project planning and

Materials Preparation development

Policy & Procedure Microsoft Word, Excel, Minute taking

Development Outlook and Power Point

PROFESSIONAL EXPERIENCE

Compliance Officer 7/13 – Present ● Integral Health Plan, Inc., d/b/a Integral Quality Care

Responsible for the development, management and oversight of the Medicaid health plan’s compliance

program. Serve as part of the health plan’s executive team and maintain direct contact and reportin g to

the Board of Directors, health plan Chief Executive Officer (CEO) and state regulator. Ensure each of

the basic elements of a compliance program are established, fulfilled and communicated throughout the

organization. Provide oversight to ensure business areas are compliant with the Contract between the

health plan and state regulator. Serve as the health plan’s Privacy Officer. Chair the compliance and

policy committees. Monitor adherence to corrective action plans. Identify compliance gaps and provid e

recommendations. Lead and assist in the preparation and completion of audits, requests for proposal and

accreditation. Lead and assist in preparing and filing regulatory reports.

Adjunct Instructor 9/11 – Present ● Briarcliffe College - Online

Facilitate online classes from approved curriculum. Motivate students to participate in all aspects of the

educational process. Maintain communication with students in online discussions to assist them in

achieving completion objectives. Provide regular, accurate, and timely assistance, feedback and support

to students relative to their performance. Keep archives of student work, correspondence, maintain and

report student participation, evaluations/grades as appropriate. Communicate with students and staff by

email and telephone as needed. Develop course curriculum on a contractual basis for the parent

company, Career Education Corporation.

Compliance Consultant 8/11 – 7/13 ● Aetna (FL & TX Medicaid Health Plans)

Assist the Medicaid Health Plan Compliance Officer in managing the compliance program. Chair the

compliance and policy committees. Track inadvertent disclosures of protected health information to ensure

compliance with the Health Insurance Portability and Accountability Act (HIPAA). Assist in the preparation

and completion of audits, requests for proposal and accreditation. Assist in preparing and filing regulatory

reports. Monitor to ensure the protection of enrollee’s protected health information. Monitor community

outreach activities and materials to ensure compliance with the Contract. Monitor the fraud and abuse hotline

and begin the investigative process to resolve issues. Serve as the single point of contact for resolving enrollee

and provider issues received from the state regulator. Provide compliance training and education. Work with

other business areas to ensure enrollees’ eligibility is accurate. Investigate reason for enrollee’s termination

and report to the claims department. Research, track and trend payment hold requests received from the OIG.

Serve as voting member on Health Plan’s Complaint Committees.

Interim Compliance Officer 3/11 – 8/11 ● U.S. Department of Veterans Affairs

Managed the facility’s Compliance Program, e.g. compliance risk assessment and training and education plan.

Chaired monthly Compliance Committee. Completed the monthly scorecard and reports for the facility’s

compliance program. Identified areas within the medical center’s revenue cycle that could generate increased

revenue. Identified compliance risks from every business line and managed them by providing training,

monitoring and auditing. Provided status reports to executive leadership. Worked with various service lines to

ensure proper documentation and coding practices. Monitored usage of Evaluation & Management (E/M)

codes to ensure the facility remained within the required standard deviation range. Collaborated with coding

service to provide E/M, encounter form completion and documentation training to providers. Reviewed and

updated compliance policies and procedures. Served on the facility Ethics Committee.

Compliance Trainee 9/09 – 3/11 ● U.S. Department of Veterans Affairs

Assisted the Compliance Officer in the management of the facility’s compliance program. Served on the

Revenue Cycle Committee. Provided job specific training to service lines and providers. Completed the

monthly scorecard and reports for the facility’s compliance program. Chaired monthly Compliance

Committee. Provided status reports to executive leadership. Worked with various service lines to ensure

proper documentation and coding practices. Monitored usage of Evaluation & Management (E/M) codes to

ensure the facility remained within the required standard deviation range. Collaborated with coding service to

provide E/M, encounter form completion and documentation training to providers.

Quality Assurance Specialist 8/06 – 9/09 ● Big Bend Community Based Care

Conducted qualitative assessments of services. Assisted in the preparation of review and survey tools.

Collected, analyzed, and reported data to improve staff performance and agency outcomes. Provided

technical assistance and best practice activities to improve casework. Participated in systemic quality

improvement projects and activities. Facilitated and provided training/education on guidelines, policy

updates and other identified training needs.

Intake/Placement Specialist 8/05 – 8/06 ● Big Bend Community Based Care

Facilitated and supervised staffing referrals from the Florida Department of Children and Families’

investigation unit. Provided on-call services for children in need of out-of-home placement after

business hours. Submitted diligent searches to locate absent parents. Determined the type of funding

children in foster care qualify were eligible to receive. Facilitated trainings with the services unit when

administrative or policy changes occurred. Identified community resources for children and families.

Child Protective Investigator 7/04 – 8/05 ● Florida Department of Children and Families

Investigated cases of child abuse and neglect received from the Florida Abuse Hotline. Provided

services to families from varied backgrounds and social status. Performed interviews based on

allegations in the reports. Participated in Dependency Court Proceedings & prepared court documents.

Performed case staffing with other internal and external agencies to develop case plans for the families.

Provided counsel to adults coping with alcohol and drug dependency and domestic violence.

Participated in the development of care and treatment plans. Mentored new Child Protective

Investigators.

EDUCATION, CERTIFICATION & TRAINING

Florida Agricultural and Mechanical University – Master of Science, Healthcare Administration

Administrative Residency – "Creating Healthier Outcomes for Children in Care”

The Florida State University – Bachelor of Science, Social Work

Certificates/Training:

Health Ethics Trust, Certified Compliance Professional

Career Education Corporation, Online Faculty Training

Berger Consulting, Green Belt Certification

Professional Affiliations:

Health Care Compliance Association (HCCA)

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