JERRY W. JACKSON

**** *** *****, ****** *** Rey, California 90292

• Home: 310-***-**** Cell: 310-***-**** • ybhm4p@r.postjobfree.com

HEALTHCARE ADMINISTRATION

Compliance ~ Regulatory Affairs ~ Senior Management ~ Provider Network Services ~ Managed Care

• Twenty plus years of Health Care Administration experience; most recent position, Director of Compliance.

• Prior positions in Director of Compliance, , Director of Regulatory Compliance, Contract Administration Provider Network Services, and Health Care Management/Managed Care.

• BS in Health Care Administration, a MS in Health Care Administration and a JD, Law.

ADDITIONAL KEY AREAS OF EXPERTISE

Staff Management Legislative Interpretation Direct/Coordinate Regulatory Audits

Audit Responses Health Law State and Federal Regulations

Educate Provider Network Organizational Operations Facilitate Dispute Resolution

EMPLOYMENT BACKGROUND / TRANSFERABLE ACCOMPLISHMENTS

MD CARE INC., Los Alamitos, California

Director of Compliance July 2007- February 2009

Overview: Responsible for the development, implementation, and monitoring of the corporate compliance program. Reported directly to the Board of Directors. Focused on program development and implementation of Compliance, Privacy, and Risk Management activities. Supported the compliance function by maintaining the privacy and confidentiality of information, protecting the assets of the organization, ensuring ethical behavior, reporting non-compliance occurrences, and adhering to applicable federal, state and local laws and regulations.

Specific Task and Accomplishments:

Developed the Corporate Compliance Program and Fraud Waste and Abuse Compliance Policy ensuring internal controls are capable of preventing and detecting significant instances or patterns of illegal, unethical or improper conduct.

Provided guidance and assistance in the identification, development, implementation, and maintenance of organizational health plan policies and procedures to ensure compliance with regulatory requirements and laws.

Monitored and evaluated compliance with Medicare Advantage contract requirements, including development of monitoring and reporting tools to ensure compliance. Communicated CMS requirements to affected departments. Interpreted and applied Medicare regulations and company policies and procedures. Lead or conducted auditing activities in multiple operational areas and assisted in process improvement efforts within operational areas.

Ensured that controls were in place to guarantee privacy and security, to identify fraud, waste and abuse and to ensure that state and federal regulations were adhered to.

Chaired the Compliance Committee was responsible for program implementation throughout the organization.

Managed the submission approval process with regulators for required reporting, marketing practices, mandated legislation, new products, benefits, new business ventures, service area expansions, and organizational decisions impacting the Health Plan, were deemed appropriate.

Facilitated and administered training and educational programs, such as HIPAA, Compliance, Fraud, Waste, and Abuse, Code of Conduct and other training programs.

Successfully filed the DMHC and CMS Service Area Expansion applications.

Successfully filed CMS Medicare Advantage Contract application.

JERRY W. JACKSON PAGE TWO

EMPLOYMENT BACKGROUND / TRANSFERABLE ACCOMPLISHMENTS - continued

Composed the Plan’s Summary of Benefits and Evidence of Coverage member marketing material.

CALIFORNIA STATE UNIVERSITY, Northridge, California 2005 – Present

Adjunct Faculty Member - Health Care Administration Program

Teach Health Law in the graduate and undergraduate programs.

UHP HEALTHCARE – Inglewood, California 2000 – Aug. 2006

HMO with revenues of $30 million and 120 employees.

Director of Regulatory Compliance (2005 – Aug. 2006)

Reporting to the Chief Administrative Officer/Executive VP, responsible for maintaining organizational compliance with Regulatory Entities. Supervise staff members.

• Review and evaluation of policies and procedures to ensure regulatory standards are met throughout the organization.

• Review current operation practices to ensure compliance with regulatory standards.

• Liaison to Regulatory Entities addressing issues presented and providing problem resolution.

• Provide oversight and management of on-site audits.

• Member of Special Investigation Unit involving development and conducting compliance investigations for all compliance concerns identified internally and externally to ensure regulatory compliance regarding Fraud and Abuse statutes.

Provider Network Manager (2000 – 2005)

Responsible for monitoring contractual compliance for multiple medical groups and IPAs.

• Provide daily problem resolution regarding service delivery, claims payment, and network maintenance.

• Contract development and implementation of new medical groups and IPAs.

• Monitor shared risk pools performance and medical group incentive programs.

• Coordinate and conduct quarterly Joint Operation Committee meetings

• Participate in regulatory audits, new provider orientation, contract interpretation, and interaction with Quality Management and Utilization Management departments to ensure contractual compliance mechanism.

HEALTH NET HMO 1998 – 1999

Case Coordinator- Appeals and Grievances

Responsible for coordination and resolution of member, employer groups, and provider appeals and grievances. And for all correspondence to members and providers regarding their cases.

• Issues included: claims payment, referral authorizations, quality of care, and service issues.

• Monitored the appeal and grievance process to ensure compliance with regulatory time frames.

FPA MEDICAL MANAGEMENT 1998

Network Coordinator

Served as liaison between IPA and the contracted health. Resolved contractual and operational issues. Provided network management including support and provider staff training and orientation.

HEALTH NET HMO 1996 – 1998

Member Services Representative

Provided member education regarding benefits, utilization of health plan and access of the health care delivery system. Resolved complaints regarding provision of benefits.

PRIOR CAREER HISTORY

NATIONAL HEALTH FOUNDATION

Program Representative

Developed and implemented State of California Tobacco Control Outreach and the Access for Infants and Mothers (AIM) Program. Duties included networking with businesses, and other local agencies to communicate program message and obtain the communities’ assistance with program implementation.

ADS MANAGEMENT/HEALTHPRO ASSOCIATES

IPA Plan Manager

Managed IPA with 10,000 member lives. Responsible for network development, maintenance and support. Additional responsibilities were: contract analysis and interpretation, implementation of provider capitation arrangements, facilitation of

JERRY W. JACKSON PAGE THREE

EMPLOYMENT BACKGROUND / TRANSFERABLE ACCOMPLISHMENTS - continued

the referral/authorization function, management of shared risk and stop loss funds, customer service staff, and participation at Board of Directors meetings.

LA VIDA MEDICAL. GROUP

Medical Center Administrator

Managed multi-specialty group practice providing capitated and fee-for-service care. Responsible for facility operations and staffing and for supervision of clinical and administrative staff members. Developed, implemented and managed a prepaid shared risk contract for commercial and Medicare subscribers.

MAXICARE HEALTH PLANS

Customer Service Representative

Acted as liaison for members and providers between the payor and outside sources.

UNITED HEALTH PLAN

Clinic Manager, Adult Medicine

Responsible for daily clinic operations and departmental planning; supervised administrative and clinical staff.

EDUCATION

JD, Law, University of West Los Angeles School of Law, Inglewood, California

MS, Health Care Administration, California State University, Northridge, Northridge, California

BS, Health Care Administration, California State University, Northridge, Northridge, California

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MILITARY SERVICE- U.S. Navy

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PUBLICATION

Collaboration Across the Disciplines in Health Care, Bartlett and Jones-2010, Chapter 12, Medicine and the Law: The Legal Perspective.

COMPUTER PROFICIENCY

Microsoft Windows Office: Word, Excel, PowerPoint, Outlook

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