Clive, Iowa, United States
Policy & Regulatory Compliance Expert | 10+ Years Driving Strategic Compliance Solutions & Risk Management. Detail-oriented problem solver and collaborative communicator with experience leveraging an understanding of compliance across industries including government, environmental, insurance, and healthcare to lead and build compliance programs, develop and enforce policies, facilitate education, and mitigate risks while aligning with internal goals and strategies.
Create, manage, coordinate, and implement cross-functional and complex policy changes and projects for credentialing department. Read and interpret state and federal laws and regulations, analyze new and changing requirements, and advise stakeholders on potential impact and risk while providing recommendations to mitigate regulatory effects. Implement policy changes, process improvements, and solutions to boost efficiency and align with project objectives. Lead Annual Compliance Risk Assessment, schedule meetings, create agendas, facilitate survey completion, develop action plans, and deliver communication to ensure appropriate messaging. Serve as SME and primary point of contact and execute and complete internal and external audits, including CMS, NCQA, BCBS Association and Delegated Credentialing.
Oversaw business operations related to value-based contracts and ACO Compliance Program, advised staff and leadership on compliance issues, and supported quality reporting, provider networks, credentialing, and finance. Analyzed and interpreted new programs, Medicare Advantage, federal regulations (CMS, HIPAA), quality standards (NCQA), and risk scoring to determine impact on policies and procedures. Managed regulatory documents with payers, including governance, BAAs, provider contracts, and CMS DUAs, and developed compliance strategies. Completed Corrective Action Requests, conducted and completed audits, and monitored network adequacy. Collaborated with regional chapter leaders to educate participants, providers, and staff on policies and procedures, trained federal grant staff on post-award issues, and educated network leaders on program changes.
While working for Conifer Health, I continued to develop my knowledge of hospital customer service and saw the need for confident and knowledgeable leadership. I built upon six years of experience: two years in clinics and four years working in an emergency room.
Environmental Specialist with experience on a variety of environmental projects including Phase I and II Environmental Site Assessment, NEPA and Section 106 Reviews and U.S. Army Corps of Engineers projects. Holds a Bachelor’s Degree in Plant Biology. Has completed ASTM 1527-05 compliant site reconnaissance field visits, reviewed local, state, and federal environmental databases, acquired and reviewed historical information, performed warranty deed and lien searches, completed interviews, and prepared Phase I and II ESA Reports. 40-hour Hazardous Waste Operations and Emergency Response (HAZWOPER) certified.