Karen Navarro

**** ********* ** 608-***-**** (Cell) Janesville, WI 53548 adzly2@r.postjobfree.com

PROFESSIONAL HISTORY

Retired and seeking a part-time, possibly remote, position

UW Health, Madison, WI February 2006 – December 2019

Privacy Specialist

In collaboration with the Director of Hospital Compliance Services, responsible for the implementation and facilitation of ongoing privacy compliance auditing, monitoring and education activities.

Provide support and guidance to ensure compliance with all federal and state privacy program regulations and administrative requirements.

Establish and administer a process for receiving, documenting, tracking, investigating, and taking action related to all patient complaints concerning privacy and confidentiality.

Review Epic electronic medical record audit trails for inappropriate accesses by employees, affiliates, clinical partners, outside organizations, consulting with Director of Compliance and Privacy Officer, as necessary.

Report all verified inappropriate accesses to management, Human Resources and Business Integrity.

Investigate complaints of Unauthorized Disclosures and ensure that appropriate remediation is completed, including potentially notifying affected patients and the Compliance Department.

Educate staff regarding various aspects of the confidentiality of patient information.

Interview staff to gather facts regarding alleged privacy violation and work in conjunction with Human Resources to ensure that disciplinary actions are consistent.

Provide developmental guidance and assist in the identification, implementation, and maintenance of privacy policies.

Serve as a resource to all departments in establishing methods to improve efficiency and reduce vulnerability to privacy issues.

Perform privacy risk assessments and conduct related ongoing compliance monitoring activities in coordination with the Office of Compliance, Human Resources, and operational assessment functions.

Senior Compliance Analyst

Participated in audit controls and measurements for internal workflow to ensure processes were accurate, complete, and compliant with state and federal laws pertaining to, but not limited to, Health Insurance Portability and Accountability Act (HIPAA), billing and coding, ancillary services, pharmacy including the 340B Drug Program, clinical research, laboratory, Office of Inspector General (OIG) Compliance Guidance(s), the Centers for Medicare and Medicaid Services (CMS), Stark Anti-Kickback, and Payment Card Industry (PCI); participated in the resolution of issues identified, as needed.

Served as an organizational resource maintaining a working knowledge of state and federal laws and regulations, including industry best practices.

Created and/or revised policies and procedures; identified, developed, and implemented system-wide risk assessment and program effectiveness evaluations; participated in annual work plans; coordinated and conducted internal review and monitoring of departmental audits, and provided corrective action guidance, as assigned.

Participated in quality, safety, and innovation initiatives and/or Root Cause Analysis identification of alternative options and revision(s), evaluated, and communicated results.

Collaborated in the maintenance of an effective compliance-training program, including new employee orientation, customized high-risk departmental training, and annual computer-based training.

Participated in receiving, processing and documentation of the Compliance Hotline incident reports.

Sustained leadership and communication skills to work with and coordinate a cross-functional team (e.g., Legal, Risk Management, Worker’s Compensation, Operations, Provider Relations, Nursing, etc.) to respond, in writing and in person, to external government inquiries and/or investigations.

Maintained organizational, proprietary, personnel related and patient confidentiality.

Content expert and team member in the creation and subsequent revisions of the first Employee Handbook.

Managed staff through work assignment, mentoring, and overseeing timelines to ensure a successful and timely completion of projects, processes, and/or tasks.

Previously responsible for coordinating, investigating and reporting Caregiver Misconduct Incident Reports to the Department of Quality Assurance and/or the Department of Safety and Professional Services; coordinated and reported Controlled Substance Diversions to the Drug Enforcement Agency and/or the Police Department, reported patient restraint/seclusion deaths to CMS; Administrator for the coordination of the CMS’ Open Payments Act (“Sunshine Act”); facilitated, implemented, processed, and maintained applications, notices, and created licensure crosswalk for the organization and individual providers pertaining to National Provider Identification (NPI).

Former team committee member: Accreditation and Regulatory Readiness, Medical Records, Legal Medical Record, Collaborative Privacy Audit, Bleeding Disorders Program, Collaborative Confidentiality (Hospital, Medical School, and Medical Foundation), Magnet Recognition Program Recognition/Appraisal Visit Team (received Magnet recognition) and the Recovery Audit Contractor (RAC) Focus and Triage Teams, and various Task Force teams

Prevea Clinic, Green Bay, WI March 2005 – May 2005

Risk Manager/Compliance Officer

Managed areas of HIPAA Privacy/Security, Risk Management and Disaster Recovery/Compliance for 14+ clinics (50% owned by physicians, 50% owned by 2 local hospitals).

Reactivated and chaired the Corporate Compliance Committee.

Created and implemented incident report logs for HIPAA security/privacy, potential legal risk management cases and clinic incidents such as workplace violence, fires, bad-weather closings, etc., which were presented to the senior management team.

Participated in and/or facilitated numerous committees within the organization as well as joint committees within the community and the clinic’s hospital partners.

Began revisions to the Corporate Compliance Program, which was outdated.

Began automating annual compliance training with the Human Resources department.

Created and provided presentation(s) to numerous departments, senior management, and the board of directors.

Reason for leaving: Resigned due to an unexpected family obligation, which required relocation from Green Bay.

National Government Services, * Milwaukee, WI April 2004 – March 2005

April 2001 – November 2003

Senior Compliance Specialist

Maintained contractual compliance with both Medicare and Medicaid programs, as both a Fiscal Intermediary Agent and subcontractor for CMS.

Member of the HIPAA Steering Committee; main contact for all Privacy research and/or questions.

Main contact for Sarbanes-Oxley and Federal Sentencing Guidelines research projects and/or questions.

Participated in CMS’ Customer Service Quality Assurance Calibration Program.

Participant in the organization’s ISO 9001:2000 Quality Management Team, which was awarded certification.

Administrator for the automation of the annual Conflict of Interest Questionnaire, which obtained, monitored, identified, and reported all conflicts of interest requiring mitigation, and generated/submitted detailed reports to CMS; received an employee recognition award.

Key team member in the confidential CMS proposal process, which included request for proposal (RFP) research and written communication, RFP submission, oral presentations to CMS personnel in Maryland, and the final revised proposal process to obtain CMS’ project contract award.

Directed efforts to communicate compliance programs, including written materials and training programs designed specifically to promote understanding of compliance issues, laws, and regulations, and consequences of non-compliance.

Wrote/presented monthly and annual compliance and ethics training for 1,400+ employees.

*Returned to NGS after employment with the Beloit Regional Hospice (due to position revision requiring nursing licensure)

Beloit Regional Hospice, Beloit, WI November 2003 – April 2004

Patient Services Director

Director of patient services; physician, facility, and community communication and education, provided supervision of nursing, social services, and medical records staff (30+).

Responsible for the planning, coordination and delivery of patient services ensuring compliance with agency policy, standards of care and applicable state and federal regulations.

Facilitator of weekly interdisciplinary group meetings with the hospice team and medical directors.

Participated in monthly Board of Directors meetings and program development management team.

Participant and team member of numerous community and county-based committees.

Implemented and contracted with outside agencies and facilities providing patient care services.

Reason for leaving: the job description was revised to require registered nursing licensure, which I do not have.

EDUCATION

Bachelor of Science Degree: Healthcare Administration from Concordia University

Associates of Science Degree: Business Management from Cardinal Stritch College

CONTINUING EDUCATION/SEMINARS

Numerous HIPAA, compliance, EPIC, Joint Commission, ethics, fraud and regulatory conferences

Numerous coding/billing seminars and software package training

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