Management Medical

JOAN E. GIBSON

Pittsburgh, Pennsylvania ***** 412-***-**** *************@*****.***

SUMMARY

Compliance professional with developed research and analytic skills having

extensive experience in all aspects of corporate governance and compliance.

Ability to research, review and deliver complex legal concepts to a

variety of audiences in a corporate environment. Effectively communicates

using various communication channels. Investigative experience and handling

of highly sensitive and confidential matters.

PROFESSIONAL EXPERIENCE

Corporate Employment Resources, Inc.

Contracted Quality Assurance Analyst - Crown Castle 2014 - 2015

Reviewed cell tower license and lease agreements, amendments and

contractually required letters and forms for legal sufficiency supporting

the Licensing Department. Developed training materials for specific

customer projects, contract nuances, and specialized templates. Identified

performance gaps and trends which resulted in document and business process

enhancements to improve customer interactions, training and procedures.

Highmark Inc., Pittsburgh, Pennsylvania

Compliance & Ethics Analyst/Consultant 2001 - 2014

Advised corporate and subsidiary directors, executive leadership,

management and staff on compliance best practices, business ethics,

government contract obligations and relevant law, rules and regulations.

. Conducted internal investigation of allegations of misconduct, fraud

and breaches of policy and procedures from hotline and other internal

and external sources; evaluated internal controls, policies and

procedures and identified risks and trends which resulted in

development of risk mitigation processes, revision to corporate

policies and procedures and education programs. Collaborated with

management and Human Resources to develop remediation plans and

strategies.

. Identified and analyzed conflicts of interest including the giving and

receiving gifts and entertainment and provided recommendations for

remediation. Researched, revised and communicated corporate Gifts and

Entertainment Policy and other corporate and departmental policies,

procedures and practices.

. Performed corporate and subsidiary wide due diligence for compliance

with Foreign Corrupt Practices Act and Anti-bribery laws; identified

key stakeholders and risk areas resulting in the development and

presentation of education programs to address same.

. Performed focused review of high risk areas; conducted corporate and

subsidiary wide contingent commissions due diligence which resulted in

changes to broker agreements, appointment processes and sales

incentive practices.

. Monitored compliance program in response to Federal Corporate

Integrity Agreement; implemented best practices in compliance with US

Federal Sentencing Guidelines for Organizations (FSGO) and the seven

elements of an effective compliance program.

. Researched laws, rules and regulations and prepared legal memoranda

incorporating relevant changes into the Code of Business Conduct;

developed training materials and other communications and programming

providing education for diverse audiences using various methodologies

and multi-media.

. Negotiated and reviewed vendor contracts and agreements for compliance

training programming and IT solutions; monitored compliance of same.

. Developed enterprise wide compliance and ethics culture survey and

communication plan; drafted, reviewed and edited written

communications and training materials for corporate and subsidiary

wide distribution.

. Partnered with key stakeholders to identify and implement a compliance

team across departments and companies.

Joan E. Gibson 412-***-**** page 2 of 2

Tucker Independent Medical Experts, Inc., Pittsburgh, Pennsylvania

Director Business Development 2014 - present

Conducts business development for physician practice panel, attorney and

clearing house referral sources. Reviews legal and medical records and

documentation; preparing summation for independent professional medical

expert examiners.

Veritus Medicare Services, Pittsburgh, Pennsylvania

Fraud Analyst II 1999 - 2001

Conducted desk review and data analysis of medical claims; identified

indices of Medicare fraud, waste and abuse. Researched Medicare law, rules

and regulations to develop cases for referral to law enforcement.

Responded to federal agency requests for data, documents and assistance

related to new and ongoing health care fraud investigations. Monitored

provider exclusion status and implemented appropriate remedial action.

Alliance Ventures, Inc., Pittsburgh, Pennsylvania

Director Medical Management 1998 - 1999

Directed professional medical management staff that provided consulting

services to primary care and specialty physician member group practices.

Developed and executed initiatives to improve quality, efficiency and cost

effectiveness lowering per member per month health care costs. Monitored

compliance with laws, regulations and voluntary accreditation standards and

policies and ensured implementation and compliance of same.

Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania

Director Purchasing/Materials Management 1995 - 1997

Director Ambulatory Care 1993 - 1995

Directed operations of materials management, procurement, central sterile,

mail room, distribution, warehouse and outpatient services including

primary and specialty clinics. Analyzed supply chain reducing operating

costs through renegotiated vendor contracts and implemented materials

management best practices. Analyzed professional and ancillary staffing;

reorganized staffing patterns which resulted in $4 million dollars

reduction in operating costs.

EDUCATION

Juris Doctorate, Duquesne University School of Law, Pittsburgh, PA

Master of Science, Health Care Administration, California State University,

Long Beach, CA

Bachelor of Science Degree, Nursing, Slippery Rock State University,

Slippery Rock, PA

Honors - Magna Cum Laude, Dean's List

Registered Nurse, Washington Hospital School of Nursing, Washington, PA

PROFESSIONAL AFFILIATIONS

Director, Association of Certified Fraud Examiners, Pittsburgh Chapter

Member, Duquesne University Ethics Network, Beard Center for Leadership in

Ethics

Contact this candidate