Resume

Sign in

Compliance Officer

Location:
Birmingham, AL
Salary:
130,000
Posted:
July 30, 2020

Contact this candidate

Resume:

Professional Profile

Experienced compliance and project management professional with a proven ability to develop effective risk analysis and management strategies that result in improved program compliance, while also driving process improvement and workflow efficiencies. Strong strategic thinker, with superior critical analysis and problem solving skills, with a track record for delivering results. Outstanding interpersonal and communication skills, dedicated to fostering collaboration among teams. Consistent record of working with teams to ensure compliance risks are proactively identified and addressed in promotion of program integrity.

Professional Experience

ENCOMPASS HEALTH – Birmingham, AL, August 2017- Present

State Regulatory Compliance Officer

Serve as the subject matter expert and advise staff on state regulatory requirements and compliance and ethics issues

Responsible for assessing state legislative and regulatory changes and providing compliance guidance to hospital personnel and Regional Presidents for operations spanning 39 states and Puerto Rico

Administer the corporate compliance program as it relates to state and local regulatory matters, including performance of audits, risk assessment and remediation efforts as needed

Serve as Civil Rights Coordinator, ensuring compliance with Section 1557 of the Patient Protection and Affordable Care Act

Responsible for First-Tier, Downstream and Related Entity compliance program

Responsible to exclusion screening program ensuring individuals and entities are eligible under state and federal healthcare programs

Provide guidance to corporate departments and hospitals regarding fair market value in compliance with Physician Self-Referral (Stark), Anti-kickback Statute, and False Claims Act laws

Serve as liaison with state hospital associations and other industry organizations in support of state and local regulatory compliance obligations

BLUE CROSS AND BLUE SHIELD OF ALABAMA – Birmingham, AL, August 2013- August 2017

Regulatory Compliance Manager, 2014-2017

Responsible for regulatory compliance program administration, including regulatory communication management, policy and procedure management, First-Tier, Downstream and Related Entity oversight, compliance risk assessment and monitoring, issue management, and corrective action plan management

Manage team of Compliance Liaisons that support all Medicare operational areas with regulatory compliance, including Healthcare Reform and Medicare Advantage Program

Serve as Chair of the Medicare Oversight Committee

Develop and implement compliance training programs

Serve as primary point of contact for CMS Account Manager, including facilitation of CMS Program Audit

Provide oversight of all Medicare Advantage operational reporting requirements

Sr. IT Portfolio Manager, 2013-2014

Lead quarterly and annual strategic planning with Senior Management to establish project portfolio

Conduct portfolio management activities including developing operational standards for project evaluation to ensure projects strategically align with corporate goals prior to approval and funding

Utilize portfolio management tools to monitor project performance including resource allocation, financial performance, schedule performance, and budget allocation

Utilize six sigma techniques and tools for process and quality improvement

Established Business-IT Quarterly Review process; this included conducting interviews with all levels of operational management to identify business pain points and technology needs, as well as conducting market analysis to identify potential technology solutions, followed by facilitating a senior management roundtable with IT and business leaders to align strategies and resources to ensure IT was working on the right projects at the right time

MOTION INDUSTRIES- Birmingham, AL, October 2012-August 2013

Senior IT Project Manager

Responsible for management and oversight of mobile applications project portfolio

Lead mobile applications development team, including establishing performance goals and conducting performance evaluations

Perform market research and analysis of emerging technologies, conduct vendor interviews and negotiate vendor contracts

Communicate regularly with all levels of management regarding status of mobile projects and initiatives

BLUE CROSS AND BLUE SHIELD OF ALABAMA – Birmingham, AL, April 2002-October 2012

CMS Operations Enrollment and Claims Manager, 2011-2012

Responsible for operations of Medicare Advantage claims and enrollment unit

Lead enrollment and claims processing staff responsible for the timely and accurate processing of claims and enrollment applications in compliance with CMS requirements for Medicare Advantage plans

Develop and implement inventory management tools and process to support real-time feedback to staff and leadership regarding area performance

Serve as primary point of contact for CMS Account Manager for all claims and enrollment inquiries

Responsible for monthly and annual CMS reporting and reconciliation processes

Develop and implement department policies, procedures and training protocols

Serve as department representative of annual open enrollment initiatives

Senior Business IT Partner, 2010-2011

Facilitate quarterly Business-IT strategy meetings; including conducting interviews with all levels of operational management to identify business pain points and technology needs, as well as conducting market analysis to identify potential technology solutions, followed by facilitating a Sr. Management roundtable with IT and business leaders to align strategies and resources

Conduct program integration management and analysis to ensure program component interdependencies are noted, accounted for in program timeline and communicated to project teams and stakeholders

Facilitate project prioritization and sequencing activities to ensure business partners and IT are working on the right projects at the right time

Build collaborative relationships between business areas and IT to improve operational efficiency and maximize resources

Claims Processing Manager, 2006 to 2010

Lead team of claims processing analyst responsible for timely and accurate processing of claims

Conducting inventory management activities to ensure business area SLAs achieved

Serve as claims project manager for regulatory mandates such as Mental Health Parity, Affordable Care Act, and ICD-10

Responsible for claims reprocessing initiatives following internal and external audit

Certifications and Professional Training

Certified in Healthcare Compliance, HCCA

Project Management Professional, PMI Certification Number: 1487555

VP of Special Projects, PMI Central Alabama Chapter, 2015-2016

FAST Professional Facilitation

Education

SAMFORD UNIVERSITY– Birmingham, AL

Master of Science in Environmental Management, 2010

Magna Cum Laude

Conducted and presented original research at the Urban Affairs Association’s 41st Annual Conference in New Orleans, LA in March 2011 on the role of local governments in advancing sustainable community development

UNIVERSITY OF ALABAMA AT BIRMINGHAM– Birmingham, AL

Bachelor of Arts in Sociology, 1999

Cum Laude

Golden Key National Honor Society



Contact this candidate