Compliance Healthcare

KATHLEEN DIGREGORIO

Las Vegas, Nevada *****, United States 562-***-**** ******@*****.***

SUMMARY

Compliance, Ethics and Auditing – implementation of compliance and ethics programs for healthcare organizations, in accord with the OIG Seven Elements of Compliance. Goal - promote an ethical and compliant culture and reduce risks within revenue cycle management, hospitals, dental and physician practices. I earned the required CEUs in compliance training and Certified in Healthcare Compliance - CHC. I have proven my ability in conducting investigations, audits, compliance training, and annual risk assessments, as well as publishing an article in Compliance Today – April 2021, a leading industry publication. I have also enhanced my skills and knowledge by completing Lean Six Sigma, CAPM Project Management, and Cascade Leadership courses.

SKILLS

• Healthcare – Seven Elements of

Compliance

• Internal Investigations – PHI/HIPAA

Data Spills and Ethical Violations

• SOX Audits – Exigent Audits

• Annual Risk Assessment – Work

Plan Development

• Compliance Training – course

development, vendor review and

required courses assignments by

role and by location.

• Microsoft Office – PowerPoint,

Excel, Word, Outlook

• Industry software – EPIC, Metrics

and Claim Scrubbers

• Create Micro-Learning, Slide Decks,

Investigation Report, SOP, Policies

and Desktop Procedures

• Certified in Healthcare Compliance –

CHC Issued 2-2024 Credential ID

130843

• New Client Implementation

EXPERIENCE

Senior Associate - Guidehouse May 2018 – April 2025

• Promotion of The Seven Elements of Compliance within a revenue cycle management organization.

• Respond to reported HIPAA - PHI – EMTALA and workplace behavior incidents promptly in collaboration with Compliance Officer. Conduct internal investigations to determine root causes and draft effective corrective action plans - CAP with Employee Relations.

• Write monthly micro-trainings and touchpoints for over 1,600 Revenue Cycle Management team members. Quarterly presentation to US based Operations Centers.

• Track regulatory changes for hospitals and physician practices through daily reviews of government and industry sites.

• Develop and complete audits to prevent and detect PHI data spills and process errors in email encryption, cash posting, Medicare Credit Balance, and Billers - government and commercial, in multiple hospital claim scrubbers.

• Project managed revision of Internal Quality Control process for patient access representatives Billers and Self Pay, and designed slide decks for operations Senior Leadership.

Quality Control Auditor – Contract employee March 2017 – April 2018

• Quality Control transactions for a For-Profit Medicaid organization. Compliance Auditor - SCAN Health Plan April 2014 – January 2017

• Compliance audits - delegated providers network – hospitals, vision care, dental network, DME and physician practices within delegated counties of California and Arizona.

• Monthly and exigent review of providers against CMS Exclusion List. Auditor – Kaiser Permanente – contract employee August 2013 – February 2014

• SOX Compliance Audits - cash, credit/debit handling, investigated cash shortages/overage, and refunds processing.

• Training, coaching team members on HIPAA verification, cash handing procedures and developed monthly presentations slide deck for Patient Access staff.

• Validated 700+ co-pay waiver requests weekly, ensuring accuracy and adherence to Kaiser Permanente's revenue cycle policies, maintaining a 95%+ compliance rate and preventing potential revenue leakage.

Career break – family June 2012 – July 2013

EDUCATION

Associate of Arts: Paralegal. Coursework in Business Management - Literature Rio Hondo College Whittier, CA

• Lean Six Sigma Yellow Belt for Healthcare Certification – 2020

• Lean Six Sigma Green Belt completed coursework – 2022

• CAPM Project Management - 30 hours coursework completed – 2024

• Cascade Leadership Training – 2023

PUBLICATION

• Compliance Today – April 2021 – The Overcoming Equation

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