Natalie Silva

*** ******** ****** *********, ** *6825 845-***-**** adrqas@r.postjobfree.com

Experienced Investigator/Auditor looking for a new position, where I can leverage my extensive background in investigations, compliance, quality control, and auditing. Committed to helping an agency or company grow while ensuring business operations follow state and federal regulations. Bilingual (Portuguese), Detail oriented, and friendly with high ethical standards.

CORE COMPETENCIES & TECHNICAL SKILLS

HIPAA & EPIC Training

Computer Software: SPSS, ECHO, SQL, SRS, SPSS, PIP, PACT,Etc.

Team Building & Management

CPT Coding

CPR, AED, & First Responder

Quality & Operational Improvement

Audit, Compliance, & Risk Mgmt.

Fraud, Waste, Abuse, & Corruption Prevention & Investigation

Individual & Vendor Background Checks

Data Analytics & Statistical Competence

Microsoft Office Suite (Powerpoint, Word, Excel, PowerBI)

Investigative Databases: LexisNexis, Accurint, E-Justice, Vendex, CMS, Etc.

CAREER HISTORY

Jan 2021– Present

Manager, Ethics & Compliance, Purdue Pharma LP.

Retrieved and analyzed data to identify potential controlled substance diversion.

Applied knowledge of data analytical techniques to determine data sets, find trends/insights, draw logical conclusions, and produce metric reporting.

Managed data analysis for the Suspicious Order Monitoring (SOM) Team and serve as subject matter expert on data management and analysis.

Created ongoing cumulative and monthly data analysis reports, reflecting trends and percentage increases for specific products.

Articulate data and effectively reported results to internal stakeholders.

Managed the annual establishment and updated the national average calculation by customer.

Research and monitored legal updates and state reporting requirements for SOM requirements.

Developed Standard Operating Procedures (SOPs) and Working Practices Documents (WPDs), as needed, both for Ethics & Compliance Department and other functions.

Assisted with state/federal reporting requirements, conducting investigations and preparing timely, accurate and complete reports.

Researched ethics and compliance issues/hot topics, as well as industry trends, best practices, federal and state guidance, especially as pertains to SOM.

Provided information, support, and background expertise to others within the Ethics & Compliance Department, as applicable, to assist in overall department operations.

Maintained strict ethical, legal adherence and confidentiality at all times.

Assisted with other Ethics & Compliance Department initiatives, audits, training, conducting investigations, assisting with state and federal health care professional (HCP) expenditure reporting, and field-based monitoring.

Jan 2019 – Jan 2021

SPECIAL INVESTIGATOR, NYC Health + Hospitals Office Of The Inspector General

Investigate fraud, waste, abuse, corruption and mismanagement investigations relating to NYC Health + Hospitals employees, facilities, entities, contractors, vendors, and other organizations that receive city funding.

Perform regular audits and investigations to ensure Health + Hospitals remain in compliance with all applicable laws, rules and regulations.

Conduct interviews of all relevant parties to a compliant, including: the complainant, victim, and witnesses.

Wrote detailed confidential reports to senior management with findings and recommended actions prior to and following an investigation/audit.

Perform & Maintain data and statistical analysis, tables, other required documentation and case files.

Conducted several multi-agency investigations, resulting in multiple arrests and prosecutions.

Develop investigative plans, review documentation, prepare relevant correspondence, and conduct fact finding and related research.

Perform background checks for city vendors, employees, and subjects in an investigation.

Assist city agencies and healthcare facilities with human resource related issues, align goals, and determine appropriate disciplinary actions when necessary.

Collaborate with city agencies, management, and employees to improve morale, work relationships, and increase productivity and retention.

Perform arrests, surveillance, and undercover operations as needed.

Perform data analyses to identify trends and/or patterns of fraud, waste, abuse, and misconduct.

Set up both auditory/visual monitoring recording devices, conduct mobile and stationary surveillance on subjects to obtain intelligence.

Collected documentation such as witness statements, video recordings and photographs to support case findings.

Saved city agencies by implementing cost-saving initiatives that addressed long standing problems.

Performed quality control reviews of all city projects to check adherence with city, state, and federal regulatory requirements.

Managed quality programs to reduce overdue compliance activities.

Applied knowledge of fraud, waste, abuse and corruption to complete several accurate and thorough compliance investigations.

Confirmed data and licensing information through investigations and notified violators of required changes to bring operations into compliance.

Advise facilities on compliance fraud and investigations, as well as potential remedies and required actions.

Performed scheduled and unannounced investigations at workplaces.

Collected detailed notes on investigations and other communications to adhere to legal requirements and enhance recordkeeping.

SEP 2017 – JAN 2019

SPECIAL INVESTIGATOR/AUDITOR, NYC Department Of Investigation

Investigate fraud, waste, abuse, corruption and mismanagement investigations relating to city employees, facilities, entities, contractors, vendors, and other organizations that receive city funding.

Perform regular audits and investigations to ensure Department of Environmental Protection (DEP) remain in compliance with all applicable laws, rules and regulations.

Monitor and ensure regular reviews related to the DEP Capital Project/DEP BT-2 Project and their operations.

Developed and enforced audit policies and administrative and technical functions.

Produced and reviewed audit reports for submission to the Inspector General and advised on audit recommendations and Internal Controls.

Identified control gaps in processes, procedures and systems through in-depth research, assessment, and suggested methods for improvement.

Developed and implemented corrective actions to bring the agencies areas in line with standards.

Supervised and developed associates and oversaw auditing activities across operational, personnel utilization and excessive billing areas.

Established internal control systems by establishing an audit program.

Interviewed business owners, explained audit scope and conducted exit interviews of audit findings.

Determined financial and operational audit areas, providing most economical and efficient use of audit resources.

Identified management control weaknesses and provided value added suggestions for remediation.

Conduct compliance audits of payments and receipts to determine compliance with New York City & state regulatory requirements.

Facilitated financial and operational audits, working with internal and external managers to communicate recommendations or issues surrounding audits.

Identified audit risks, assisted budget preparation, and coordinated with management and audit team in preparing related reports.

Wrote detailed confidential reports to senior management with findings and recommended actions prior to and following an investigation/audit.

Maintain legal and regulatory compliance related to management of employees, city agencies, and contractors.

Perform data analyses to identify trends and/or patterns of fraud, waste, abuse, and misconduct.

Manage quality assurance program, including on-site evaluations, internal audits and customer surveys.

Saved city agencies by implementing cost-saving initiatives that addressed long standing problems.

Monitored safety programs to verify compliance with city, state, and federal standards.

Performed quality control reviews of all city projects to check adherence with city, state, and federal regulatory requirements.

Managed quality programs to reduce overdue compliance activities.

Directed and implemented strategic improvement plans to integrate solutions to audit findings and workflow process issues.

Performed quality reviews with management to uncover workflow issues.

Applied knowledge of fraud, waste, abuse and corruption to complete several accurate and thorough audits.

Performed scheduled and unannounced investigations at workplaces.

APR 2015 – AUG 2017

MEDICAL STAFF SITE AUDITOR, Montefiore Medical Center

Collected impact data and generate required reports and statistics as needed.

Act as a liaison for providers, coordinators, and outside departments for provider expirables documentation.

Organize and maintain hardcopy and electronic files for individual providers.

Update, maintain, and organize provider credentials.

Verify and ensure all providers are compliant and credentials are maintained and updated before date of expiration.

Assist staff with routine audit-related tasks such as obtaining, reviewing and logging credentials required for audits.

Maintain, update, and prepare all provider’s credentialing files for audits as needed.

Review monthly, quarterly, and annual provider certification and license reports.

Ensure that all provider documentation and files for audits are complete and organized.

Identified management control weaknesses and provided value added suggestions for remediation.

Identified audit risks and coordinated with management and audit team in preparing related reports.

Developed and implemented corrective actions to bring business arears In line with standards.

Facilitated operational audits, working with internal and external managers to communicate recommendations or issues surrounding audits.

Prepared working papers, reports and supporting documentation for audit findings.

Resolved conflicts and negotiated mutually beneficial agreements between parties.

Drove operational improvements which resulted in savings and improved profit margins.

FEB 2015 – MAR 2015

MANAGER DISASTER RECOVERY & OUTREACH, Volunteer New York!

Collect impact data and generate required reports and statistics as needed.

Collaborate with staff to ensure projects are aligned to support organization-wide strategic initiatives.

Cultivate and maintain collaborative partnerships with partner agencies Westchester & Putnam Bureau of Emergency Services.

Maintain and deepen relationships with local key disaster relief organizations that use volunteers after a disaster.

JUL 2012 – MAR 2015

ADMIN ASSISTANT & RECEPTIONIST, Dermatology Associates Of Western CT

Executed record filing system to improve document organization and management.

Monitored premises, screened visitors, updated logs and issued passes to maintain security.

Managed databases converting complex data into easy-to-interpret data.

Interacted ad communicated easily with department personnel and the public.

Identified new methods to optimize medical records management.

Trained new direct reports on department procedures and policies to maximize department effectiveness.

Managed quality assurance program, including on-site evaluations, internal audits, and customer surveys.

Coached new employees on administrative procedures, company policies, and performance standards.

Worked with the billing department in order to systematically complete administrative tasks such as posting of patient payments, coordinating patients and doctor schedules.

Responsible for HIPAA training of all employees.

Developed and updated spreadsheets and databases to track, analyze and report on performance and sales data.

Supported logistics for programs, meeting and events, including room reservations, agenda preparation and calendar maintenance.

JAN 2014 – AUG 2014

INTERN, Putnam County Bureau Of Emergency Services

Formulated, revised, and updated the County’s Comprehensive Emergency Management Plan, Emergency Action Plans, and Emergency Response Plans.

Collaborated and coordinated with County officials and consultants to aid in the formulation of the County’s Multi-Jurisdictional Hazard Mitigation Plan and Hazardous Materials Contingency Plan.

Referred cases to law enforcement agencies as needed.

Assess and research potential threats and risks to the County’s stability.

Assisted in the preparation and activation activities of the County’s Emergency Operation Center.

Developed presentation of intelligence information from all sources and plans to support risk operations and intelligence strategies.

Completed ICS 100, 200, and 700

MAY 2010 – JUN 2012

BILLING ASSOCIATE, Medical Management Corporation Of America

Responsible of billing New York Medicaid using ePACES.

Contact payers via phone and the internet to verify eligibility and applicable benefits including effective dates of coverage, limitations and exclusions, co-pays, deductibles and/or co-insurance.

Provided assistance with clerical tasks such as document scanning and distribution.

Acquired fee schedules online and encoded data into the software.

EDUCATION

NYC Department of Investigation Peace Officer Academy, Graduated, June 2018

New York, NY

MBA in Fraud Management and Economic Crime, Graduated, December 2016

*GPA: 3.78

UTICA COLLEGE, UTICA, NY

Bachelor of Science in Corporate and Homeland Security, Graduated, May 2014

Minor in Business Management

* Delta Mu Delta, Business Honor Society

* GPA: 3.61

MERCY COLLEGE, Dobbs Ferry, NY

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