Charita Bryant, CHC, PESC

Tampa, Florida

aduhkx@r.postjobfree.com

813-***-****

Professional Accomplishments

Provided healthcare compliance consulting services for Medicare Parts A, B, C & D to include but not limited to compliance program/plan reviews, risk assessments analysis, internal and external audits.

Oversaw regulatory compliance activities for hospitals, managed care organizations, managed behavioral health organization and contactors to the Federal Bureau of Prisons (BOP), US Marshals Service, Veterans Administration, Department of Defense’s Bureau of Medicine and Surgery operations including: provider credentialing & enrollment, claims processing, appeals & grievances, agent/broker marketing, vendor oversight, HIPAA privacy & security, human resources & training and EHR System Selection.

Served as the healthcare data privacy & information security subject matter expert (SME). Advised on specific legislative and regulatory mandates, managed information privacy risk assessments and conducted related ongoing corrective action and monitoring activities.

Education, Certifications & Licensure

Bachelor of Science in Health Administration with a concentration in Health Management, University of Phoenix, 2014

Certified in Healthcare Compliance (CHC), Health Care Compliance Association, 2011

Certified Provider Enrollment Specialist (PESC), DecisionHealth, 2019

Certified Notary Public, State of Florida

Related Software & Computer Applications

Microsoft Office Suite, Google Office Suite, Microsoft Project, Microsoft Visio, Microsoft SharePoint, HPMS, MMIS, Archer eGRC, CAQH

Professional Experience

Maxim Healthcare Services

National Recruitment Manager 08/2022 – Present

Staffing medical facilities, clinics and healthcare related organizations with Allied Health professionals and medical support personnel.

Overseeing allied health and medical support staff day to day activities during assignments.

University of Virginia – Medical Center

Recruiter (Temp) 03/2022 – 08/2022

Full recruitment lifecycle for healthcare related positions including position posting, interviewing, selection, salary offers, offer letters, background checks and the onboarding process.

Healthcare Consulting & Solutions Services, LLC

Healthcare Consultant 11/2011 – 03/2022

Consulted clients on all operations and business activities to ensure they produce the desired results and are consistent with the overall strategy and mission.

Identified recruiting strategies designed to identify qualified candidates through various recruiting tools (phone, email, and text) to source candidates; Evaluated, screened, and interviewed various contract & permanent healthcare professionals to determine suitability with client requirements.

Developed and maintained relationships with health plans on behalf of provider offices and facilities. Including all phases of contracting, credentialing, and claims resolution.

Oversaw all aspects of external credentialing/re-credentialing for healthcare providers including obtaining provider information and entering into databases such as CAQH and PECOS, completing applications and following up with enrollment applications for government program (Medicare, Medicare & Tricare) and commercial health plan payers, and managing the ongoing participation requirements of the plans for all practitioners enrolled.

ARC

Senior Business Analyst – Medicare Advantage (Consultant) 10/2019 – 04/2020

Developed an extensive understanding of the business unit's function and effectively communicates technical issues and solutions in non-technical terms to the business unit.

Supported Medicare Advantage related business initiatives through business process analysis, identification of implementation barriers, development of user requirements, procedures, and problems to improve existing processes.

Identified ways to enhance performance management and operational reports related to new business implementation processes.

Responsible for leading/facilitating business requirements gathering and determining operational impacts.

Accretive Solutions / RGP 2017 – 2021

Sr. Business Analyst – Human Capital Management 09/2017 – 05/2019

Business Analyst – Human Capital Management / EHR Software Selection Project (Consultant) 04/2020 – 06/2021

Led key activities including workflow assessment, workflow optimization, roll-out planning, developing training plans, change management roadmap, Go-Live Support and Post Go-Live Support planning.

Developed a thorough knowledge of the existing HCM data, process mapping, and data conversion requirements to understand how existing data must be mapped into the new operational systems.

Identified risks associated with business objectives and evaluating the controls in place to mitigate those risks to improve the effectiveness of risk management, control, and governance processes.

Used knowledge of healthcare, information systems, data privacy and information technology security to recommend the Electronic Medical Record Software (EHR) system to gather, store, interpret and manage data that is generated from care provide to patients.

Facilitated the communication and translation of functional, technical and regulatory requirements between the software vendor(s) and health services client.

Digital Intelligence Systems, LLC (DISYS)

Regulatory Business Analyst – Privacy & Security (Contractor to UnitedHealthGroup) 9/2015 – 6/2017

Monitored healthcare privacy & security regulatory bodies for changes potentially impacting the business (national and international), created impact assessments of changes, and coordinated with business partners to understand and document standard operating procedures (SOPs) associated with regulatory change.

Collaborated with Data Privacy leadership and Enterprise Information Security programs to ensure consistent communication regarding General Data Protection Regulation (GDPR), HIPAA and other privacy related compliance projects.

Advised on specific Governance, Risk and Compliance (GRC) requirements such as legislative drivers or regulatory mandates and consults on approaches to comply with business/technical SOPs and regulations with an enterprise-wide focus.

Coordinated and facilitated initial and periodic information privacy risk assessments and conducted related ongoing corrective action and compliance monitoring activities in coordination with the compliance and operational assessment functions.

Beacon Health Options (fmr. ValueOptions, Inc.)

Compliance Analyst (Contractor) 1/2015 – 9/2015

Served as consultant to management regarding Medicaid & Medicare products, benefits, interpretation, implementation and auditing.

Developed and implemented of HIPAA Privacy & Medicare Compliance training program to ensure adherence with all required regulatory and company requirements and standards.

Oversaw creation and remediation of corrective action plans to reduce or eliminate risk resulting from non-compliance with contract requirements or performance deficiencies.

Responsible for the monitoring and operation of the delegation oversight component of the compliance program, ensuring adherence to all required regulatory and company requirements and standards.

Health System One (HS1)

Compliance Manager (Contactor) 4/2014 – 12/2014

Served as key resource on local, state & federal Compliance, HIPAA & Security regulations and serves as a resource for employees, providers and vendors.

Developed and monitored the Compliance & Anti-Fraud Program and staff. Provides oversight and guidance to business owners to meet the requirements of the seven Compliance Program elements.

Initiated, facilitated and promoted activities to foster HIPAA privacy awareness and procedures, to include quarterly desk audits; collaborated with department managers to address noncompliance.

Oversaw all regulatory audits related to the Medicare & Medicaid lines of business including audits or reviews by CMS, the Office of the Inspector General, Office of Civil Rights and/ or State regulatory agencies. Activities include but are not limited to oversight of audit preparation, response to audit inquires, regulatory interviews and development, implementation and reporting corrective action plans.

Simply Healthcare Plans (SHP)

Sales & Marketing Compliance & Special Investigations Unit (SIU) Manager 6/2013 – 4/2014

Developed a comprehensive prevention, detection, investigation and correction program for fraudulent practices by sales agents, employees, providers, members and other vendors.

Reviewed, monitored and reported complaints against sales agents or brokers received by Beneficiaries, Center for Medicare & Medicaid Services (CMS), Office of Inspector General (OIG) & State Departments of Insurance (DIO) to ensure Medicare Parts C & D marketing guidelines infractions or prohibited sales tactics are detected early & appropriate corrective actions are taken immediately.

Provided subject matter expertise on Sales and Marketing guidelines. Stayed abreast of and monitor changes to CMS and FL MMA guidelines and regulations and recommend enhancements/modification to all Sales and Marketing Compliance Program and member facing collateral.

Collaborated with the Business Intelligence Unit to develop prospective and retrospective fraud and abuse detection, investigation, recovery, and avoidance.

TFI Resources/Protiviti

Appeals & Grievances Quality Analyst/Business Process Auditor (Consultant) 10/2012 – 6/2013

Responsible for the analysis and development of quality and productivity measurements to simplify and/or improve processes, determining performance standards, that align with regulatory expectations and internal expectations, by tracking and trending data.

Conducted quality audits on all A&G/CTM type cases and phone calls to ensure compliance with Medicare Managed Care Manual, Chapter 13 and the Prescription Drug Benefit Manual, Chapter 18.

Utilized guidelines and review tools such as, MACESS and FACETS to conduct extensive research and analyze the A&G issues and pertinent claim level data to either approved or route to Utilization Management staff for further review.

Provided on-going feedback to A&G investigators or other groups, in support of the departments continued process improvement and performance measurement efforts.

Archcare Advantage

Regulatory Compliance Specialist (Contractor) 4/2012 - 9/2012

Identified areas of potential compliance risk and develop solutions for risk mitigation; ensures CMS' compliance and program integrity obligations are met with a comprehensive program that includes fraud, waste and abuse elements.

Coordinated the Plan’s efforts to ensure compliance with governmental contracts, and Medicare Advantage requirements.

Monitored the release or Disclosure of PHI to ensure compliance with privacy policies and procedures.

Participated in CMS Risk Adjustment Data Validation (RADV), Medicare Part C and Part D Reporting, Data Validation and CMS Annual Program audits, entrance and exit conference(s), and facilitated, coordinated, and assisted with the development of timely corrective actions plans (CAPs).

Provided regulatory guidance to the management of First Tier, Downstream, and Related Entities (FDRs) regarding contract and regulatory requirements; performs audits, to include the request, receipt and closure of corrective action plans, when necessary.

ValueOptions, Inc.

Compliance & Program Integrity Manager 8/2011 – 3/2012

Developed and presented compliance training to staff and providers that includes fraud prevention, HIPAA and Compliance awareness.

Operated as the primary resource and contact for all fraud, waste and abuse investigation and prevention, provider monitoring and audit related activities with the State, Office of Inspector General (OIG) and Attorney General and the Medicaid Fraud Control Unit (MFCU).

Investigated reports of alleged or suspected fraud, waste or abuse, and ensures investigation is finalized per organizational policies and procedures.

Complied with the Maryland Department of Health and Mental Hygiene (DHMH) / Mental Hygiene Administration (MHA) contract with ValueOptions and associated program to ensure that contractual obligations are communicated and implemented.

Worked with Compliance Officer and other leaders as needed to ensure policies are kept up to date and available.

CIGNA Government Services (CGS)

Compliance Specialist/Business Process Auditor 3/2011 – 8/2011

Managed projects to develop, implement and track corrective action plans in response to internal and external reviews and directives as it relates to Medicare Financial Management, Certification Package of Internal Controls (CPIC) and ISO Certification.

Performed gap analysis and industry requirements review related to FISMA, OMB metrics, Plan of Actions and Milestones (POA&M) and produced executive management reports on current practices that expose an organization to privacy and/or security risks.

Conducted Human Resource Self Review of Federal and State employment laws including compliance with Service Contract Act (SCA), FLSA, ERISA, COBRA, EEO and Workers Compensation.

Monitored completion of divisional corrective action plans to external review findings; conducts follow up audits of corrective action plans to ensure successful implementation.

UnitedHealthcare

Business Compliance Analyst 3/2009 – 3/2011

Reviewed, monitored and reported complaints against sales agents or brokers received by Beneficiaries, Center for Medicare & Medicaid Services (CMS), Office of Inspector General (OIG) & State Departments of Insurance (DIO) to ensure Medicare Parts C & D marketing guidelines infractions or prohibited sales tactics are detected early & appropriate corrective actions are taken immediately.

Audited Medicare Advantage (MA) and/or Prescription Drug Plan (PDP) business processes to ensure they include adequate controls, are operating efficiently and effectively and are in compliance with internal and external guidelines. Also, documented the results of the audit and makes recommendations when needed.

Responsible for sales agent outreach and retraining regarding marketing allegation results from beneficiary complaints, secret-shoppers and other sources; conducted non-routine audits, documented & communicated findings and recommendations.

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