Compliance Program Manager at Affinity Home Care (2016-01 – Present)
Pioneer a CMS compliance framework that achieved full regulatory alignment and safeguarded $8M+ in funding, ensuring uninterrupted delivery of critical healthcare services.
- Pioneer a CMS compliance framework that achieved full regulatory alignment and safeguarded $8M+ in funding, ensuring uninterrupted delivery of critical healthcare services.
- Establish compliance monitoring, manage staff training, and prepare quarterly reports to meet federal and state deadlines, achieving zero violations during state regulatory inspections and maintaining continuous audit readiness.
- Streamlined patient intake and scheduling processes by integrating automated software for privacy acknowledgements and mandated forms, reducing onboarding time by 40% and ensuring HIPAA-compliant record retention.
- Verify the accuracy and appropriateness of claims processing, coding, billing, and reimbursement practices to improve revenue cycle cash flow and reduce the risk of denials or rejections.
- Analyze EMR audit trail and user access reviews to detect unauthorized activity, providing actionable recommendations for corrective measures, strengthening a culture of privacy and data integrity.
- Implement a GPS-enabled caregiver clock-in system to combat fraud, waste and abuse in billing and healthcare services, reduce non-compliance risk by 80%, and enhance service accuracy.
- Lead exclusion screening process, encompassing professional licensing, credentialing, and OIG/LEIE checks, resulting in a 50% reduction in onboarding time and ensuring seamless and compliant staff integration into the program.
- Developed 25+ compliance training programs to strengthen staff competency and customer service delivery, raising regulatory adherence by 85% and cutting non-compliance incidents significantly.
- Maintain 50+ policies and standard operating procedures (SOPs) for compliance monitoring, covering data privacy, billing, coding, service documentation, Anti-Kickback Statute, False Claims Act, and FWA prevention, improved operational efficiency and ensuring consistent adherence to state and federal healthcare regulations.
Community Support Specialist/Behavioral Health Case Manager at BJC Behavioral Health (2011-01 – 2016-12)
Led compliance and risk management efforts across cross-functional teams to oversee case management for 20+ patients, ensuring access to essential healthcare services and driving a 30% reduction in hospitalizations within 12 months.
- Led compliance and risk management efforts across cross-functional teams to oversee case management for 20+ patients, ensuring access to essential healthcare services and driving a 30% reduction in hospitalizations within 12 months.
- Spearheaded audit and compliance monitoring analysis to identify non-compliant behavior, administering targeted corrective actions and penalties that disincentivized providers from repeated violations and minimized compliance breaches.
- Oversee individual support plan (ISP) submissions, conducting audits of documents to identify discrepancies to ensure timely compliance with government regulations and strict adherence to deadlines.
- Orchestrated psychiatrist and medical appointments, transportation services, and access to community resources, leading to a 25% improvement in clients' independent living skills and adherence to prescribed medication regimens.
- Implemented secure and compliant healthcare information management practices, ensuring that all client data was transmitted and stored following HIPAA regulations, achieving a 100% compliance rate during internal audits.
- Advanced system information leveraging Electronic Medical Records (EMR) with policy changes and customer data to guarantee data integrity and up-to-date records, improving treatment processes and enabling instant access to healthcare information for multidisciplinary teams.
- Integrated compliance and risk management improvement initiatives with system-wide projects and strategic aims to ensure review of compliance and risk management issues for inclusion.
- Instituted compliance risk management initiatives into strategic projects, maintaining adherence to CMS guidelines and 42 CFR Part 2 to improve patient care.
- Maintain accurate and complete documentation on compliance audits on Department of Mental Health and CMS guidelines to identify patterns and trends in non-compliance and facilitate continued funding of programs for vulnerable populations.
Consultant, Medicaid Provider Enrollment & Compliance License & Certification Specialist at Waiver Consulting (2025-01 – 2026-12)
Delivered compliance advisory to healthcare startups launching Medicaid-funded HCBS providers, interpreting Medicaid policy, CMS regulations, and Medicaid program requirements to ensure regulatory readiness across 50 states and 900+ programs.
- Delivered compliance advisory to healthcare startups launching Medicaid-funded HCBS providers, interpreting Medicaid policy, CMS regulations, and Medicaid program requirements to ensure regulatory readiness across 50 states and 900+ programs.
- Directed Medicaid provider enrollment and credentialing including provider attestations, ownership disclosures, NPI registration, and licensure documentation to ensure full compliance with CMS and state enrollment standards.
- Conducted risk assessments for provider eligibility, taxonomy classification, and credentialing requirements, identifying gaps and implementing corrective strategies prior to program launch.
- Translated federal and state regulations into structured enrollment checklists, compliance playbooks, and licensing readiness frameworks supporting provider program launch.
- Architected AI-assisted compliance and operational systems (dashboards, tracking tools) to streamline processes, reduce manual effort, and strengthen audit readiness.
