Experience

California Department of State Hospitals

• United States
• Hospitals and Health Care
• 700 & Above Employee

• Associate Governmental Program Analyst (AGPA), Non-Compliance Prevention Program Lead

  • Jul 2020 - Present

  • Lead the Patient Cost Recovery Section’s Non-Compliance Prevention Program (NCPP.) Review and evaluate processes performed within the section to ensure compliance with State and Federal statutes, regulations, and written procedures. Work closely with each SME’s within the section to document areas of compliance and non-compliance, process improvement opportunities, and confirm that each step of procedures are completed accurately. Document areas of risk and non-compliance and make recommended solutions to management. • Responsible for writing Policy Directives (PD), Information Bulletins (IB), and Operational Procedures (OP) for the Financial Services Division. Research and analyze State and federal statues and regulations which support Policy Directives. Track documents through formal routing process, address stakeholder feedback, and draft revisions. Assist in the development of desktop procedures in collaboration with program SMEs. Coordinate and facilitate meetings, create agendas and produce meeting minutes in collaboration with the development of PD, IB, and OP. Maintain master list of all documents to be drafted and regularly update management on status of documents. • Collaborate with internal and external stakeholders for process improvements. Provide training and technical assistance to impacted program areas and offer overall guidance and support to hospital staff. Responsible for the more complex research assignments, and provide updates and recommendations to management to mitigate identified risks. Show less



CENTENE HEALTH INSURANCE

• RANCHO CORDOVA, CA

• Marketing & Member Materials Specialist

  • Jun 2020 - Jul 2020

  • Prepare marketing and member materials as required by CMS regulations and health plans • Assure accuracy of all documents and compliance with applicable CMS regulations, and/or State regulations, and complete review approval checklist(s) • Submit documents to CMS via HPMS as required per CMS regulations • Submit MMP documents to agencies as required by CMS and State • Maintain current knowledge of CMS regulations pertaining to member and marketing materials and document submission requirements • Collaborate with health plans and corporate operational departments to identify and create materials and assure appropriate document content • Create and/or maintain departmental policies and procedures to reflect changes in regulation and/or departmental processes • Create and/or maintain member and marketing material style guides to reflect regulatory updates to marketing requirements and/or departmental processes Show less



VSP Vision

• United States
• Hospitals and Health Care
• 700 & Above Employee

• Regulatory Compliance Specialist

  • Nov 2018 - May 2020

  • Research, analyze, and respond to client, regulatory agency, and internal requests for compliance information. • Review new and revised regulations applicable to Medicaid and Medicare programs, and compile data from reference material and use of various resources including Westlaw, Lexis/Nexis and the Internet. Analyze the information and make recommendations regarding applicability to business and business’s compliance status. • Act as a resource to other departments regarding Medicare/Medicaid, HIPAA and ERISA regulations. • Assist business partners in fully understanding regulatory requirements and assist in identifying methods and alternatives for implementation into the business environment. • Develop, recommend, and document company-wide compliance policies, which include plan design and departmental procedures. • Review and update provider communication relevant to regulatory issues. Show less



Heritage Community Credit Union

• Financial Services
• 1 - 100 Employee

• Compliance, BSA and Privacy Officer

  • Dec 2001 - Oct 2018

  • Develop, implement, and provide oversight of Compliance Management Program in conjunction with Board of Directors and Senior Management. Manage regulatory change process while minimizing effects on business growth. • Develop compliance policies and procedures, and review, update and maintain policies and procedures to address regulatory changes. • Develop, implement, and provide oversight of Consumer Complaint Program, and communicate updates to appropriate personnel when compliance requirements are not met or when compliance requirements or processes are modified to address risks identified by consumer complaints. • Develop, implement, and provide daily oversight of BSA/AML/CDD program and controls, including oversight of annual risk-assessment, independent audit, and exam responses. Communicate risks and updates to Senior Management and Board of Directors, provide day-to-day oversight of BSA/AML/CDD monitoring, and review BSA/AML/OFAC alerts and file CTRs and SARs. • Research and communicate complex compliance and legal matters to Senior Management and Board of Directors and collaborate with business units to implement new policies, procedures, controls, and training programs to ensure ongoing compliance with applicable laws and regulations. • Regulatory Exam Preparation: Collaborate with Senior Management, business units, and auditors to identify program vulnerabilities and to implement effective controls to mitigate risks and to ensure successful audits and exams. • Provide oversight of Privacy Program (GLBA, CA Financial Privacy Act, CalOPPA and COPPA) to ensure privacy policies are implemented and followed. Review and approve the sharing of all non-public personal information released by institution. Show less