Compliance Manager

• Apr 2022 - Present

Compliance

• Sep 2019 - Mar 2022

Tango performs utilization management and other delegated services for multiple health plans in several states. I am excited to assist with this company's growth and have confidence in our ability to adhere to regulatory requirements and support a culture of compliance while maintaining fiscal stability in our little corner of the health care world.Focusing on the 7 elements of an effective compliance program, my director and I look for ways to identify and mitigate risk. In addition, project management is key when juggling various internal/external compliance and operational deadlines. How I support my leader(s): - Reporting: Monthly & Quarterly ODAG / Part C Reports and Grievances - Auditing and Monitoring: self-dubbed internal audit queen and master assist in preparation and response to external audits; claims, credentialing, compliance, UM, privacy and security- Quality-Performance-Utilization-Compliance Committee: created companywide process for metrics used monthly/quarterly for NCQA and Health Plan reporting- Licensing: SOS, DHS, Nurse, Physician, TPA, UR-URA licensure and research/assist Clinicians. Researched 18+ state requirements for PHCN- Policies and Procedures: research and write new or revise the old as requirements are ever changing- File Preparation: organize company or member files for NCQA-accreditation or Health Plan Review- Education and Training: covering company and health plan related topics, state/federal regulatory requirements, compliance, privacy, security and other hot topics in clear/concise formats that help our workforce understand "why" the information is important and how they are impacted- Other fun items: Board reports, quarterly/annual roll-ups, work plans, program evaluations Show less

Manager, Network Development

• Apr 2018 - Jun 2019

- Managed a highly skilled team dedicated to Provider Relations Activities for High Volume Providers (Hospitals, Behavioral Health Hospitals, FQHCs, Large Provider Groups and Labs) to provide assistance with orientation/education, credentialing and claims for all product lines (Medicare Advantage, Marketplace, AHCCCS/Medicaid) within Centene's AZ Market. - Managed multiple projects/deadlines to ensure adherence to regulatory and reporting requirements, production and quality standards. - Managed/monitored and collaborated with Marketing on all external provider updates, new/changes to provider manuals, assigned plan policies and other electronic and paper media or marketing materials. Show less

Interim Director/RT.DME Compliance & Privacy Officer

• Dec 2017 - Mar 2018

Licensing and Accreditation Manager

• Nov 2014 - Dec 2017

-Manage and oversee a 450+ licensing and accreditation process across 60+ locations in 10 states, as well as revising and ensuring policies, procedures, and credentialing are up to date in all lines of business. -Lead and prepare the survey process and local inspections, including the training on regulatory expectations to staff.-Govern company policy and procedure processes for RT.DME lines of business.-Direct the competitive bidding process, oversee and monitor contract requirements.-Possess a thorough understanding of HIPAA requirements and privacy best practices, breach prevention, updates, and OCR alerts.-Create compliance reports for the Executives and Board of Directors as needed and in absence of CO. -Follow the 7 elements of a successful compliance program for internal auditing. -Serve as Delegated Official and bestowed with Power of Attorney in several states.-Spearhead Due Diligence for acquisitions and mergers. Show less

Government Compliance Supervisor

• Jun 2011 - Nov 2014

-Created quarterly quality assurance reports for Performance Improvement Program.-Collected and managed Patient Satisfaction Surveys and Performance Improvement Surveys.-Responded to all BBB, Attorney General Audits, and administrate internal company complaints.-Completed Government Payer Audits for Company Stock or Asset acquisitions as part of the Acquisitions team. -Assisted with new, change of address, and change of ownership and terms licensing.-Updated DMEPOS and HIPAA requirements for company education purposes. Show less

Sr. Government Compliance Representative

• Mar 2009 - Jun 2011

-Processed Medicare and Medicaid Payer Enrollments, company licensing for all branches, and internal -Government Payer audits for all lines of business including, DMEPOS-Durable Medical Equipment, Infusion Pharmacies, and sleep labs. -Instructed branches on performance improvement and created performance improvement reports.-Assisted with new hire compliance training.

Insurance Coordinator

• Sep 2007 - Mar 2009

-Processed time-sensitive treatment eligibility and authorizations with Commercial, Medicaid, and International insurances. -Secured funding for treatments from insurance authorizations and charitable agencies. -Scheduled PT/OT, Physicians, and patients for treatments. -Processed time-sensitive treatment eligibility and authorizations with Commercial, Medicaid, and International insurances. -Secured funding for treatments from insurance authorizations and charitable agencies. -Scheduled PT/OT, Physicians, and patients for treatments.

Revenue Qualifications Team Lead

• May 2001 - May 2005

-Served as Medicare Accounts Processing System Liaison between state branches, billing centers, beneficiaries, staff, and Medicare agencies. -Performed Quality Assurance Coordination: included federal and state government insurance, billing, and collection processes. -Authored department protocol for the billing center and state branch training manual. -Served as Medicare Accounts Processing System Liaison between state branches, billing centers, beneficiaries, staff, and Medicare agencies. -Performed Quality Assurance Coordination: included federal and state government insurance, billing, and collection processes. -Authored department protocol for the billing center and state branch training manual.

Office and HR Administrator

• 2000 - 2001

-Implemented and ran a complete office system, including managing multiple priorities on a daily basis. -Ensured company’s compliance with federal labor laws, postings, and filings. -Saved company over $5000 on Insurance Bill. -Performed Human Resources duties which included leading New Hire Orientation and payroll. -Coordinated Architect Bids for Building Re-Design -Implemented and ran a complete office system, including managing multiple priorities on a daily basis. -Ensured company’s compliance with federal labor laws, postings, and filings. -Saved company over $5000 on Insurance Bill. -Performed Human Resources duties which included leading New Hire Orientation and payroll. -Coordinated Architect Bids for Building Re-Design

Teller and Phone Center

• 1999 - 2000

-Performed teller duties for several branches which included: Receipt and Dispensing of Cash, auditing drawers, open/close procedures. -Processed intake for loan apps and closing procedures on approved loans. -Answered 60-100 calls per day depending on nature of call working in the Phone Center. -Performed teller duties for several branches which included: Receipt and Dispensing of Cash, auditing drawers, open/close procedures. -Processed intake for loan apps and closing procedures on approved loans. -Answered 60-100 calls per day depending on nature of call working in the Phone Center.