TONYA FULLEN

Fayetteville, GA *****

aditkj@r.postjobfree.com

770-***-****

OPERATIONAL COMPETENCIES

Identified areas of compliance vulnerability and risk and ensured corrective action plans were developed and implemented when compliance issues are revealed.

Developed, evaluated and implemented compliance, audit and oversight requirements, policies, operating procedures related to activities and processes involved with the monitoring and oversight of program integrity to remediate risk and vulnerabilities.

Assisted with methodology and practice guide refinement, and consulting training development and delivery. Management experience including responsibilities for hiring, training, assigning work and managing performance of staff.

PROFESSIONAL EXPERIENCE

FIRST DATA - Atlanta, GA 9/16 -9/18

Senior Consultant

Developed methodologies to advise agencies on how to best ensure that agencies are addressing non-compliance.

Managed relationships with strategic partners, understanding tool(s) product(s), and participating in client/potential client meetings that involve tool demonstration.

Supported capture management and business development, including proposal contributions.

Supported the Enterprise Services Center of Excellence to help mature the consulting practice in targeted markets.

Analyzed program data to identify trends, patterns, assess quality, and program compliance.

PUBLIC CONSULTING GROUP - Atlanta, GA 5//15-9/16

Senior Advisor

Implemented all State Directive and applicable clinical policy and administrative codes. Analyzed program data to identify trends, patterns, identified training issues, monitored employee performance, assessed quality, and program compliance.

Managed incident investigatory process and program.

Led comprehensive investigatory process, prevention planning, provider education, fraud and overpayment referrals, and other program components.

CENTERS FOR MEDICARE AND MEDICAID SERVICES - Atlanta, GA 11/07 – 05/15

Program Integrity Team Lead

Conducted national reviews of State Program Integrity Functions while reporting non-compliance and program vulnerabilities to include implementation and oversight of federal compliance initiatives.

Coordinated and lead site visits, Interviewed agency staff and provided feedback through a comprehensive program report.

Initiated Corrective Action Plans which included reviews of operations, policies, procedures and contract requirements in accordance with Federal Regulations.

Analysed and interpret data and present the findings clearly, producing written remedial plans, including training, to address gaps that are tracked through to completion.

KAISER PERMANENTE - Atlanta, GA 6/06-10/07

Fraud Lead

Implemented the program-wide fraud, waste and abuse related compliance initiatives and ensured

the execution of national compliance directives within the region.

• Provided oversight of internal investigations resulting in revisions of internal controls and policies and procedures.

• Chaired and participated in several committees related to business and risk management.

• Coordinated the Ethics and Compliance Hotline and Compliance, Legal, and Human Resources

Investigations.

FLORIDA OFFICE OF THE ATTORNEY GENERAL -West Palm Beach, FL 6/98 – 12/04

Senior Investigator

Successfully investigated and resolved instances of healthcare fraud and/or abuse conducted by medical professionals.

Initiated court proceedings, presented cases to prosecutors, prepared affidavits, obtained sworn statements for both criminal and civil prosecutions, testified in judicial proceedings, and conducted medical records and claims reviews.

Served as the Compliance and Regulation Coordinator for Elder Abuse cases and Task Force Lead for Patient Abuse and Neglect Investigations.

EDUCATION

Master of Science (MS) in Fraud and Forensics

Carlow University, Pittsburgh, PA

Bachelor of Health Services Administration (BHSA)

Florida International University, Miami, FL

ADDITIONAL SKILLS

Certified Fraud Examiner, United States Army and Army Reserves, Military Police

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