Regulatory Affairs Compliance Officer

RoxAnne Y. Lockhart, BS, MSA

Address: Harrison Township, MI 48045 Mail: ***********@*****.*** Phone: 313-***-****

PROFESSIONAL SUMMARY

Talented, accomplished, and results-oriented professional with extensive management experience and demonstrated achievements spanning more than 2 decades in regulatory affairs in the healthcare industry. Strong background encompassing Compliance, HIPAA Privacy, and Consulting. Successful career engagement in leading health plans, managed care organizations, medical groups, hospitals, and integrated delivery systems. Excellent analytical, research, training, and investigative skills. Dexterous at identifying issues, synthesizing conclusions into recommendations, and implementing action plans. Performance-oriented leader, highly regarded for the ability to drive processes, motivate cross-functional teams, and work well under pressure to manage and meet multiple project deadlines. Enhance communications and understanding between business areas resulting in a collaborated approach to promoting compliance with applicable laws and contractual obligations. Career supported by MSA – Administration, BS – Health Services Administration, and CHC and ELHP certifications.

CORE COMPETENCIES

Regulatory Affairs

Compliance / Privacy

Medicaid / Medicare

Healthcare Services Administration

Risk Assessment & Mitigation

Audit / Investigation

Strategic Planning & Tactical Execution

Program & Project Management

Training Communications & Education

Consulting / Advisory

Standards & Procedures

Team Collaboration & Leadership

Monitoring & Oversight

Analytical Problem Solving

Process Improvement

WORK EXPERIENCE

Chief Compliance Officer Gainwell Technologies (contractor) March 2021 – Present

Served in a client facing role as the Medicaid state contractor compliance officer, developing and administering the organization's pharmacy compliance program.

Communicated compliance information to the State’s senior leadership. Oversee compliance audits and risk assessments and implement their findings.

Develop reports and analyses to expose potential risks and gaps that need corrective action or preventative action.

Monitored all state and federal regulations affecting pharmaceutical personnel and report on upcoming changes in federal and/or state laws.

Organized regular training sessions for employees to communicate key regulatory changes and updates.

Partnered with ODM legal counsel and finance departments to identify and monitor critical risk areas, plan for mitigating risks, and develop action plans.

Reported violations as appropriate or required and properly notify the state of key compliance-related issues.

Partner/Consultant Compliance Reliance Healthcare Consulting, Bloomfield Hills, MI May 2017 – Present

Provide professional healthcare compliance consulting services to small and midsize providers.

Conduct effectiveness assessments of provider compliance program using DHHS OIG, FSGO, and State Medicaid guidelines.

Design corrective action plans including monitoring, auditing, education, policy development, investigation techniques, develop self-disclosure protocols, and HIPAA/HITECH Breach process reviews.

Develop sample code of conduct along with an implementation plan.

Draft sample leadership reports for C-Suite, Board of Trustees, and Compliance committee using an FSGO-acceptable format.

Compliance Investigation Officer Detroit Medical Center (DMC)/Tenet Health, Detroit, MI September 2018 – December 2019

Utilized working relationships to investigate compliance-related allegations reported through the Ethics Action Line (EAL), Compliance Officer, Privacy Officer, Law Department, and/or any other source.

Independently investigated/supervised the investigation including interviews, standardizing the resolution plan, remediation, and root cause analysis.

Collaborated with the Compliance Officer, Facility Executive Leadership, Privacy Officer, and Human Resources to recommend and oversee corrective/disciplinary action resulting from actions taken during the investigation.

Conducted a closure meeting with the related department lead and closed the loop with individuals involved in the investigative process.

Maintained compliance with documentation requirements within the EAL case management system.

Director of Compliance/Privacy Accomplish Therapy, LLC, West Palm Beach, FL June 2014 – October 2016

Using business processes, designed and controlled the Ethics and Compliance and Privacy Programs as a contract therapy provider under arrangement with 84 skilled nursing facilities in the SE Region. Recruited and trained compliance specialists with clinical and administrative skills to administer the program under the direction of the Director of Compliance. Oversaw all organizational compliance education, audits, and investigations. Developed risk-based programs to ensure alignment with Federal and State regulatory initiatives. Collaborated with operations and education to provide a full-scope effective program. Managed the company appeals and denials to improve payer relations and claim outcomes. Prepared leadership reports for the compliance committee and senior leaders of the organization. In coordination with the CEO's operational strategies, drove the company’s reputation, identity, and branding to the communities served.

Achievements:

Created and distributed quarterly compliance newsletter to over 900 staff to ensure timely compliance communications.

Created and implemented an effective marketing campaign tool that incorporated the Company mission and values, the compliance officer contact information, and the hotline contact information onto all staff identification badges.

Ethics & Compliance Officer Palms West & JFK North Hospitals, Loxahatchee, FL January 2012 – June 2014

Implemented, aligned, and managed the corporate ethics and compliance program for two member HCA hospitals with over 500 acute and psychiatric beds. Investigated and created remedial action plans for issues involving misconduct or inappropriate behavior based on Federal, State, and/or company policies. Created and presented program reports to Board of Trustees, leadership, and management. Owned and leveraged community, Board of Trustee, and leadership relationships to ensure depth of the program is achieved. Presented and monitored employee participation with Code of Conduct annual training based on system requirements. Key strategist in creating the ethics and compliance vision for both hospitals. Routinely evaluated compliance and ethics risks by monitoring industry and corporate standards with actual employee and physician behaviors. Worked closely with the Privacy and Information Security officers concerning matters of HIPAA privacy and security violations. Served as the hospital's Good Government Group Legislative Liaison for 2013-2014.

Achievements:

Analyzed complex compliance investigation data in order to generate simple risk-based trend reports with recommendations for leadership.

Improved efficiency in the compliance program by generating automated projections for high-cost or high-risk services that were reimbursed in excess of $500,000 in a year by Medicare.

Chief Compliance & Privacy Officer Healthcare District Palm Beach County, Palm Springs, FL June 2011 – January 2012

Served as the District’s sole compliance and privacy expert for all issues concerning adherence to federal and state regulations and District policy. Obtained counsel from Legal Affairs to ensure District, state, and Federal contract requirement compliance. Oversaw both compliance and privacy operational audits to ensure the District’s adherence to regulation and; created useful corrective action plans where opportunity existed. Complete oversight for all education and other elements of an effective compliance program. Created all compliance audits and monitoring plans and reports for District Board and senior leadership. Owned relationship with Board and senior leaders regarding all elements of the compliance and privacy programs to ensure open, consistent communication and program support to make certain that strategic goals were being met.

Achievements:

Received Board approval to expand the Compliance Officer role to include Privacy to ensure the organizational structure complied with Federal and state standards and laws.

Obtained Board consent to conduct an annual compliance risk assessment.

Compliance Officer Henry Ford Health System, Detroit, MI November 2006 – April 2011

Served as Compliance Officer for a 903-bed tertiary, teaching hospital, 28 ambulatory sites and employed medical group with over 1,100 medical staff, mid-level providers, and members. Served as a primary corporate resource for fraud and abuse regulation interpretation and dissemination. Managed online compliance education for hospital and medical group. Developed, owned, and implemented corporate compliance policies and programs. Created and continued to oversee the Compliance Council (CC) to ensure it was properly staffed, aligned with system strategic goals and operated effectively. Promoted a culture of self-reporting and resolution for all compliance issues including hotline-related activities. Worked closely with legal and patient financial services to resolve suspected non-compliance, misconduct, and/or inappropriate billing. Served on multiple leadership councils at the will of the CEO. Managed the organization’s first system-level security breach under the HIPAA/HITECH security rule in the absence of the Chief Information Security Officer.

Achievements:

Developed a system-wide approach to conducting a thorough Compliance Effectiveness Assessment for all system hospitals and clinics based on the Federal Sentencing Guidelines for Organization (FSGO).

Had complete control and oversight for an OIG investigation with a potential overpayment of $673,000.00. Case was closed favorably to Henry Ford with no repayment to Medicare.

Additional Experience includes Adjunct Professor, Palm Beach County Congressional Field Organizer (temp.), Corporate Responsibility Officer, Organizational Integrity Manager, and Regional Provider Affairs Representative positions (Between 1995 and 2016).

EDUCATION

MSA, Administration Central Michigan University, Mt. Pleasant, MI

BS, Health Services Administration University of Detroit-Mercy, Detroit, MI

CERTIFICATIONS & LICENSE

CHC, Health Care Compliance Association (HCCA), Minneapolis, MN (eligible)

ELHP, Executive Leadership for Healthcare Professionals, Cornell University, Ithaca, NY

MEMBERSHIPS & PROFESSIONAL AFFILIATIONS

HCCA, Health Care Compliance Association

T Leroy Jefferson Medical Society, West Palm Beach, FL

League of Women Voters (LOWV) Palm Beach County, FL

BOARDS / RECOGNITIONS

Palm Beach County, FL, Office of Equal Opportunity, Board Member (2015 – 2017)

2013 Legacy Magazine Annual Healthcare Business & Industry Leader of the Year

VOLUNTEER ACCOMPLISHMENTS

Habitat for Humanity 2019 Positive Image Award Recipient

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