Dr.Raul Sanchez, MBA, MSHSA, LHCRM, OHCC, CHCO

Pembroke Pines, Florida 33027• 305-***-**** • ad0jg2@r.postjobfree.com

Healthcare Administration

Certified Compliance Officer and

HIPAA, Security Ethics Compliance

Licensed Risk Manager

Professional experience reflects over 25 years of executive leadership.

1.Strategic executive and influential leader known for fueling operational excellence, growth, developmental areas, and a team member working along with Healthcare Providers, HMOs, MSOs, and Medicare Advantage healthcare facilities, by providing Corporate Compliance and Risk Management, Valued Based Programs Compliance to senior leadership, medical centers, physician groups, and diagnostic facilities.

2.Strengths: An outstanding communicator, fluid in English and Spanish, with well-defined interpersonal skills; combined strong executive presence with excellent relationship management and abilities to effectively govern. Skilled team player, staff management with strong background in managing diverse environments. Independent handling assignments, ready to go beyond basics requirements. Equipped with good computer skills. Knowledge of utilization control, AHCA, HIPPA, OSHA and accreditations of Joint Commission presentations.

Areas of expertise include…

Healthcare Administration Experience

Organizational Effectiveness

Health Services Administration

Licensed Healthcare Risk Management

Certified Corporate Compliance

Valued Based Programs Compliance

Maintenance of proper levels of confidentiality.

RELOCATION IS ACCEPTABLE

Risk Analysis

Strategic Alliances and Partnerships

Certified HIPAA Compliance Privacy and Security

Analysis of Trending Indicators

Effective organizational and time management skills.

Root Cause Analysis

Education & Credentials

Master’s Degree in Business Administration

NOVA SOUTHEASTERN UNIVERSITY, Miami, FL

Master’s Degree in Science in Health Service Administration

NOVA SOUTHEASTERN UNIVERSITY, Miami, FL

Doctorate Degree in Medicine

UNIVERSIDAD CATÓLICA NORDESTANA, San Francisco de Macoris, Dominican Republic

Trainings & Certification

American Institute of Healthcare Compliance -Healthcare Corporate Compliance Certified,

American Institute of Healthcare Compliance- Certified HIPAA Compliance, Privacy and Security.

American Institute of Legal Medicine, Healthcare Risk Management

Risk Management State of Florida Licensed, # 5502071

Florida Legal Institute Certified Medical-Legal Consultant

Professional Experience

PROSTOCARE OF SOUTH FLORIDA, INC., Miami, FL

COO / Administration / Management 2000 - Present

Creative with strong leadership and motivational skills; extremely service oriented; unique combination of intuitive and analytical abilities; astute at recognizing areas in need of improvement, with the vision to develop action steps. Developing contracts with HMO’s, MSO’S and hospital settings.

Provided leadership, oversight, and direction for the successful implementation and completion of a complex initiative to improve health services. Monitored all facets of operation, business development, corporate networking, strategic alliances, and staff management while ensuring consistent program messaging, communications, and reporting activities. Established and enforced standard operating procedures, coordinated office activities and operations to secure efficiency and compliance to company policies. Developed Risk Management, Corporate Compliance, HIPAA Compliance activities Ethics, patient organizational integrity privacy, and Value Based Care Department.

Presently monitoring the day-to-day activities of clinics to further their compliance objectives. conducted and supervised investigations as appropriate. Experience in Federal Healthcare enforcement looking into irregularities as: Fraud, Waste, Abuse, Anti-Kickback, Code of Conduct, Stark Law, Self-Referral, and False Claim Act. HIPAA Privacy and Security Rules, overseen Security, physical and technical safeguards. Audit serious irregularities. OSHA and Compliance.

Well-developed communication and interpersonal skills. Robust interpersonal skills, with evidence of teamwork and collaboration. Strong written/verbal communications and high-level sales presentation experience.

Bilingual English and Spanish native language.

Organizing personnel, implement training, managed work-related activities.

Coordinated investigations with legal counsel for major violations of law or policy.

Monitored and executed follow-up, as applicable, implementing corrective actions to investigations and other issues generated by the compliance and privacy programs.

Successfully developed and maintained productive long-term provider client relations with local and national managed care organizations.

Coordinated risk assessment methodologies and developing key deliverables, including process flows, work programs, reports, and control summaries.

Ability to multi-task and oversee multiple engagements and work streams with various clients.

Identified current and emerging regulatory risks, developed, and implemented risk mitigation plans, and provided regular reporting to senior leadership.

Managed regulatory examinations, internal and external audits, inquiries.

Reviewed all reports of risk incidents on a timely basis and evaluate them to identify actual or potential patient injury, follow up as necessary.

Competencies:

Drives Results: Consistently achieves results, even under tough circumstances.

Communicates Effectively: Developing and delivering multi-mode communications that convey a clear understanding of the unique needs of different audiences.

Builds Effective Teams: Building strong identity teams that apply their diverse skills and perspectives to achieve common goals.

Situational Adaptability: Effectively building formal and informal relationship networks inside and outside the organization.

Customer Focus: Building strong customer-centric relationships and delivering customer-centric solutions.

Demonstrates Self-awareness: Using a combination of feedback and reflection to gain productive insight into personal strengths and weaknesses.

Business Insight: Applying knowledge of business and the marketplace to advance the organization's goals.

Financial Acumen: Interpreting and applying understanding of key financial indicators.

KNOWLEDGE, SKILLS, AND ABILITIES:

Strong business acumen and relationship skills with a keen understanding of business controls and operations in OSHA, Regulatory, Compliance, and Risk Management.

Advanced knowledge of business and management principles involved in strategic planning, resource allocation, human resource modeling, leadership technique and operations.

Superior knowledge of principles and processes for providing customer service including customer needs assessment, meeting quality standards for services and evaluation of customer satisfaction

Knowledge and implementation of regulatory requirements and laws that govern clinic activities.

Exceptional track record of driving revenue growth and controlling expenses.

Ability to effectively leverage business and organizational knowledge within and across functions.

Exceptional written and verbal communication skills with a high degree of emotional intelligence and integrity; driven and focused work ethic

Exceptional organizational and management skills, including the handling of multiple projects simultaneously and meeting tight deadlines; self-starter with the ability to think creatively and work effectively.

Passionate about serving others with VIP experiences; ability to naturally engage and connect with others.

Proficient in Microsoft Office Suite products including Word, Excel, PowerPoint and Outlook, database, and presentation software.

Ability and willingness to travel locally, regionally, and nationwide up to 50% of the time.

Spoken and written fluency in English

Developed and implemented appropriate policies and procedures including, a systematic process to assure that incidents were reported to the appropriate managers and Quality/Patient Safety Committee for process improvement and follow-up.

Investigated incidents/adverse events to identify potential or actual claims and reported them to the Claims Administrator.

Identified trends and risk mitigation opportunities ensuring implementation at all levels of and across the organization.

LARKIN COMMUNITY HOSPITAL, Miami, FL

Directed activities and programs for hospital which include quality, accreditation, regulatory agencies, risk, patient safety, and/or infection control.

Director Risk and Safety Management 1997 – 1999

Implemented the Risk and Safety Program for the hospital and affiliated business units. Developed policies and procedures for state and federal surveys; interacted with key persons during site visits from regulatory agencies, including ACHA, State Agency Surveys as well as JCAHO and OSHA. Participated in Patient Rights, Corporate Compliance, Peer Review, Patient Safety, Root Cause Analysis, Infectious Control, Compliance, Performance Improvement, Safety, and Ethical committees.

Partnered with Infection Control, Compliance, Environmental, Engineering, Imaging, Cardiovascular Non-Invasive, Security, and Dietary departments to decrease risk and improve patient care.

Improved overall safety rating of the facility by educating employee in Risk and Safety prevention.

Consulted division leaders on potential risk management issues including potentially serious safety, risk or claim issues.

Coordinated and evaluated punctual reports of risk incidents in order to identify actual or potential patient injury and, if needed, a follow up

Implemented a protocol to interact with patients and caregivers on complaints of substandard care, injury, and other concerns in collaboration with nursing, physicians, managers, and Patient Advocates.

Developed and executed appropriate policies and procedures such as a systematic process to assure that incidents are reported to the appropriate managers and Quality/Patient Safety Committee for process improvement and follow-up.

Looked into incidents and adverse occurrences to pinpoint potential or actual claims and report them to the Claims Administrator.

Professional Associations

American Institute of Healthcare Corporate Compliance

American Society of Professionals in Patient Safety

Florida Association Risk Management and Patient Safety.

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