Health Manager

Deborah M. Johnson, M.S., M.H.A., Ph.D.

**** ******** **. **** 770-***-****

Mableton, GA 30126 ***********@*******.***

Summary of Qualifications

Experienced health care professional with effective: verbal, written, and presentation skills; works well with all levels of an organization and its business partners. Proficiencies in the following areas:

Healthcare Regulatory Compliance • Commercial, Managed Care/ Health Plan Operations

Healthcare Delivery Process Improvement • Hospitals and Private Practice Management

Project Management • Public Health Delivery and Management

Management Consulting • Contracting and Negotiation CVS/Aetna Illinicare, Vice President Compliance- Chicago, Illinois (2020-2021- Illinicare acquired by CVS Health)

Serve as the senior compliance leader and work stream lead responsible IlliniCare/CVS/Aetna integration.

Responsible for executive oversight of the Illinois health plans’ compliance program.

Provide compliance guidance related to new and revised healthcare policy and regulations.

Responsibility for developing, implementing and maintaining effective compliance controls for the health plan. Centene- Corporation (2014-2020)

IlliniCare Health Plan, Vice President Compliance- Chicago, Illinois (2018- 2020)

Responsible for executive oversight of the health plans’ compliance program.

Provide compliance guidance related to new and revised healthcare policy and regulations

Responsibility for developing, implementing and maintaining effective compliance controls for the health plan. Peach State Health Plan, Senior Director, Compliance & Internal Audit, Atlanta, Georgia (2014- 2018)

Provided compliance program and Internal Audit oversight management functions for Georgia’s premier Managed Care Organization (MCO). The Health Plans compliance responsibility including; training, communication and coordination of policy development, compliance investigations and corrective action plans.

Responsible for accurate and timely submission of all Health Plan contract deliverables for all product lines

(Medicaid, Medicare, Commercial Insurance) and business service deliverables.

Serve as point of contact for health plan compliance for vendor interactions. Manage and direct correspondence and daily interaction with all state and federal regulators.

Provide oversight and direction for internal and external compliance audits and compliance business processes.

Manage audit findings and deliverables. Write corrective action plans and work with internal department managers to ensure timely completion of audit responses in compliance with federal, state and local regulatory requirements.

Work directly with Corporate Compliance, Vendor Oversight, and internal Executive Management to ensure effective and efficient compliance processes for the health plan and subcontracted vendors.

Accountable for the management and oversight of the compliance process for all health plan material subcontractors; provide compliance direction and ensure performance requirements are met.

Work collaboratively with the Plans’ Contract Management department to ensure compliance with State Medicaid programs requirements outlined in the MCO’s contract.

Work directly with internal managers and leaders for Medicare and Ambetter (commercial) products to ensure compliance with CMS and DOI requirements.

Design, perform and manage risk-based audits, including strategic, financial, operational, compliance and IT audits.

Responsible for evaluation of controls and health plan processes, effectiveness, efficiency and risk mitigation strategies.

Work with subject matter experts on design of recommendations, appropriate controls and operational efficiencies/effectiveness and make recommendations for operational improvements.

Oversee and manage audit planning, including risk assessment, scope development, review and refinement of the audit programs.

Monitor and report on the status of historical audit findings to Corporate and Health Plan Executive Management.

Serves as the health plan point of contact for external audit teams to perform continuous audit readiness and alignment with audit schedules.

Adventist Health System Regional Corporate Responsibility Officer- Southeastern Region (2014)

Served as the Corporate Responsibility Officer for the southeast region of Adventist Health System (AHS). 1 P a g e

Deborah M. Johnson, M.S., M.H.A., Ph.D.

4589 Kinsdale Dr. HOME 770-***-****

Mableton, GA 30126 ***********@*******.***

Responsibilities included oversight of the day-to-day compliance operations of all hospitals, physician practices and ancillary facilities in Georgia, North Carolina, Tennessee, and Kentucky.

Facilitated monitoring and auditing activities for various business lines in the region including acute care, home health, hospice, long-term care, durable medical equipment, infusion, and physician practices.

Coordinated and managed the contract management system specific to physician contracting for the region.

Provided training and education on all AHS policies regarding regulatory compliance to ensure consistency across the region.

Provided regional oversight for responses to hotline calls, including investigations and corrective action plans.

Accountable to educate regional facility staff and leadership concerning corporate responsibility policies, HIPAA privacy issues, physician contracting, and other general regulatory corporate responsibility topics.

Managed and coordinated all external audits.

Responsible for identifying unique compliance risks to the region and developing corrective action plans for mitigation.

Presented compliance and corporate responsibility activities to regional facility boards of directors.

Acted as liaison and corporate support for the Hospital Corporate Responsibility Associates. Carson Heggie Consulting Group LLC, Principal Consultant, Regulatory Compliance, Atlanta, GA (2013- 2014)

Responsible for building partnerships with healthcare organizations to provide all aspects of compliance program management and oversight.

Served as healthcare client engagement manager to ensure timely compliance project deliverable milestones and effectively manage concerns or roadblocks related to the overall goal of the engagement.

Served as the healthcare industry knowledge resource.

Provided compliance risk assessments, compliance program development and management, and served as interim compliance officer.

Highland Rivers, Chief Compliance and Privacy Officer Dalton, Georgia (2010- 2013)

Served as a member of the administrative team with corporate responsibility for developing and implementing a compliance program for the second largest provider of behavioral health services in the state of Georgia.

Provided compliance direction and oversight to 11 counties throughout the State of Georgia.

Advised the organization’s Senior Management Team and Governing Board members on issues of regulatory compliance and ethics.

Monitored, assessed and audited the organization on a variety of regulatory compliance requirements and business controls.

Worked collaboratively with business unit leaders to develop corrective action plans that optimized internal process performance while ensuring compliance with regulatory and legal requirements.

Developed and implemented an audit toolkit used to evaluate business processes, compliance program effectiveness, and enhanced compliance functions throughout the system as necessary to carry out collective compliance responsibilities.

Investigated all actual and potential issues of non-compliance reported via the hotline and other means throughout the organization. Created, implemented and monitored all corrective action plans and reported findings to the compliance committee and Governing Board as needed.

Served as the organization’s HIPAA Privacy Officer for the purpose of ensuring compliance with the Health Insurance Portability and Accountability Act (“HIPAA”) and HITECH requirements. 2 P a g e

Deborah M. Johnson, M.S., M.H.A., Ph.D.

4589 Kinsdale Dr. HOME 770-***-****

Mableton, GA 30126 ***********@*******.***

Dentons LLC, Compliance Practice Manager, Healthcare Consulting Group, Washington, DC (2009-2010)

Served as a member of the management consulting team for the world's largest law firm, responsible for delivering quality and value add healthcare compliance services to multinational healthcare organizations.

Responsible for managing compliance oversight, monitoring and auditing for compliance engagements.

Responsible for developing, and delivering compliance program effectiveness strategies and tools for healthcare clients and related engagements.

Tenet Healthcare Corporation (2004-2009)

Compliance and Ethics Officer North Fulton Regional Medical Center, Roswell, Georgia (2007- 2009)

Served as the system’s executive facilitator responsible for implementation, maintenance and oversight of Tenet’s Compliance Program obligations under the guidance of a Corporate Integrity Agreement (CIA) with the Federal Government; advised Senior Management and Governing Board on related issues. Conducted “live” Compliance and Ethics training for all staff and Contractors, as required under the Corporate Integrity Agreement, and monitored execution of online compliance and ethics education.

Audited and monitored billing error reports and worked collaboratively with the Chief Financial Officer (“CFO”) on internal audits, trends and risk areas.

Collaborated with the quality and case management departments to monitor, track, trend, and resolve identified compliance issues identified in the Compliance Work Plan.

Served as Chairperson for the Hospital Compliance Committee (“HCC”). Monitored preparation, implementation, and maintenance of facility contractual agreements with all referral sources (physicians). Reviewed and audited all physician payments.

Reviewed and approved all referral source agreements prior to execution to ensure compliance with Stark and Anti- kickback requirements.

Managed the Contracts Administrator and worked with Chief Legal Counsel to ensure compliant contracting practices were performed; including appropriate due diligence.

Served as the system’s HIPAA Privacy Officer. Collaborated with hospital personnel to conduct periodic quality reviews and audited processes related to appropriate utilization of services.

Accessed the peer review process for effectiveness and appropriateness of actions, including documentation of the process. Identified trends and patterns that indicated potential or actual compliance issues.

Investigated all actual and potential issues of non-compliance reported via the hotline and other means throughout the organization. Created, implemented and monitored all corrective action plans and reported findings to the compliance committee and the governing board as needed. Compliance & Ethics Officer Brookwood Medical Center, Birmingham AL (2004-2007)

Served as the hospital system’s executive facilitator for the implementation, maintenance and oversight of Tenet’s Compliance Program for the flagship hospital. Responsible for all aspects of the compliance program and the requirements and obligations under the guidance of a Corporate Integrity Agreement (CIA) with the Federal Government.

ACS State Health Care, Operations Consulting Group; Functional Principal Consultant, Atlanta, GA (2003-2004)

Served as a member of the management team responsible for provider and member enrollment for Medicaid and Medicare for the State of Georgia.

Provided HIPAA compliance oversight, monitoring and auditing for all Medicaid/ State Healthcare Fiscal Agent accounts; developed HIPAA training curriculum and training materials for State Healthcare Agent accounts; rolled out HIPAA training initiatives to all engagement accounts; and tracked and audited the effectiveness of HIPAA training initiatives for all State Healthcare accounts.

Served as Claims Operations Manager for the State of Hawaii’s Medicaid Operations. Healthlink Inc; Senior HIPAA Consultant, Houston, TX/Atlanta, Georgia (2001-2003)

Conducted HIPAA privacy assessments, training and participated in tactical and remediation planning for the fourth largest health system in the U.S. The assessment consisted of a sampling of corporate offices, hospitals, specialty and dental clinics, and eligibility centers and affiliated hybrid entities. 3 P a g e

Deborah M. Johnson, M.S., M.H.A., Ph.D.

4589 Kinsdale Dr. HOME 770-***-****

Mableton, GA 30126 ***********@*******.***

Conducted roll out of HIPAA remediation services for Horizon Blue Cross Blue Shield of New Jersey. Created privacy processes for organization wide HIPAA compliance.

Provided organization wide HIPAA training for managers and staff relating to newly created processes.

Conducted HIPAA needs assessments, risk analysis, information flows and remediation for all hybrid entities affiliated with the Hospital Authority.

McKesson Corporation; Engagement Manager/Sr. Consultant, Consulting Services, Alpharetta, GA (1998-2000)

As member of the McKesson HIPAA team, responsible for development, rollout and management of all HIPAA Consulting Services (CSG) for ITB business units and internal HIPAA compliance.

Accountable for all HIPAA speaking engagements, articles, and intralink-wesite development deliverables relative to HIPAA Consulting Service.

Accountable for all toolkits and methodology development for HIPAA CSG.

Responsible for managing all HIPAA project deliverables, staffing, project pricing, education, and expert project management and oversight for ITB customers.

IBM/ISSC/ICOR; Project Manager, Support Services and Help Desk, Atlanta, Georgia (1996- 1998)

Recruited as health care delivery expert to develop and implement support services for an enterprise wide health care application for integrated health care delivery systems and community based health networks.

Provided leadership while interfacing with providers and external customers to obtain cooperative efforts to develop enterprise solutions and support that were consistent with IBM/ISSC strategies market trends. Grady Health System; Director- Network Development, Atlanta, Georgia (1994- 1996)

Served as a member of the pioneering team that developed and implemented Georgia’s first Medicaid managed care, HMO, PCCM, and PHSN initiative in the State’s largest public health facility.

Developed strategies for provider linkage and performed critical review analysis of key competitors with Grady Healthcare Inc.

Developed and implemented business plans, policies/ procedures, and promotional strategies. Education and Certifications

Cornell University

Johnson School of Management Ithaca, New York

Executive Leadership for Healthcare Professionals, Certification Seton Hall Law School

Newark, New Jersey

US Healthcare Compliance, Certification

Mercer University

Stetson, School of Business and Economics, Atlanta, GA Masters, Healthcare Policy and Health Administration Century University, Albuquerque, NM

Doctor of Philosophy, Health Care Management

Clark Atlanta University

Atlanta, Georgia

Bachelors of Arts, Fine Arts

4 P age

Deborah M. Johnson, M.S., M.H.A., Ph.D.

4589 Kinsdale Dr. HOME 770-***-****

Mableton, GA 30126 ***********@*******.***

International Studies Program, Mercer University

Healthcare Administrative Residency

St. Petersburg Russia, Hospital #2

International Studies Program, Mercer University

The World Health Organization, Studies in Health Disparities Presentations:

Presenter, “Conducting Risk Assessments for Various Third Parties: Agents Vendors JV’s, Suppliers” 2018 Third Party Management & Oversight Summit

Presenter, “Compliance Facelift: Sculpting a program from Good to Great” 2019 Healthcare Compliance Association

(HCCA) Annual Managed Care Conference

Presenter, “Proven Methods to Streamline & Optimize FDR Oversight” 2019 Healthcare Compliance Association (HCCA) Annual Managed Care Conference

Presenter, “Auditing and Monitoring” 2018 Healthcare Compliance Association (HCCA) Annual Managed Care Conference Presenter, “Compliance Auditing and Monitoring” 2017 Compliance Week Europe (CWE) Annual Compliance Conference Amsterdam Holland/Europe

Presenter, “Compliance Auditing and Monitoring” 2018 Healthcare Compliance Association (HCCA) Annual Managed Care Conference

Presenter, “Compliance Program Makeover, From Good to Great” 2017 Healthcare Compliance Association (HCCA) Annual Managed Care Conference

Presenter, “Auditing and Monitoring for Managed Care Plans” 2017 Healthcare Compliance (HCCA) Annual Compliance Institute

Presenter, Assessing Compliance Readiness in the Current Healthcare Landscape" Metrics Stream, Educational Webinar 2015

Presenter, “Compliance Program Makeover, From Good to Great” Healthcare Compliance Association (HCCA) Educational Webinar, 2014

Panel Presenter, “Recent Developments in Compliance and Cooperation” Healthcare Compliance Association (HCCA) Southeast Annual Conference

Presenter, “Compliance Matters” Alabama Society of Volunteer Directors, Conference, Gulf Shore, AL Presenter, “HIPAA Compliance and Benefits” HFMA 2001 ANI Annual National Conference Presenter, “Gauging Your HIPAA Readiness: Compliance, Benefits, and Solution” Annual Health Information Management Systems Society (HIMSS) Conference and Exhibition Community Involvement/Board Appointments:

Metro Genetic Corporation (MGC)- (Member)

Advisory Board Member- Cobb County Juvenile Courts (CASA)

Junior League of Cobb-Marietta (Member)

Alpha Kappa Alpha Sorority Incorporated (Member)

United Way VIP Program (Alumni)

Deborah M. Johnson, M.S., M.H.A., Ph.D.

4589 Kinsdale Dr. HOME 770-***-****

Mableton, GA 30126 ***********@*******.***

Professional Membership:

Health Care Compliance Association (HCCA)

American College of Health Care Executives (ACHE)

National Association of Health Services Executives (NAHSE)

National Association of Business and Professional Women (NABPW) Information and Technology Profile Systems Software MS Office Suite, MS Project, MultiMate, MS-Access, Lotus 1-2-3, IDX, MEDITEC, DARS, Workfront Healthcare Information Technology

GRC Archer, Compliance 360, Navax Global, Archer, Knowledge of interface requirements and gap analysis; Technically familiar with Series, and STAR Patient Care, Lab, Radiology and Pharmacy products; Capable of performing VAN Connectivity and using SocksCap32

6 P age

Contact this candidate