| Candidate Information | | Title | Health Care Business Development | | Target Location | US-NJ-Marlboro |
| | 20,000+ Fresh Resumes Monthly | |
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Click here or scroll down to respond to this candidateSUMMARY PROFILE:An experienced heath care compliance professional with more than 20 years assessing regulatory activities of healthcare providers, payors, etc., to ensure compliance with federal and state requirements and a proven track record in developing policies and procedures for compliance programs, as well as establishing audit protocols for a range of healthcare entities. Competencies also extent into reviewing the HIPAA privacy programs for different healthcare organizations, both providers and payors. Skills include serving as. Healthcare analyst and researcher, adept at handling transactional advisory services, performing due diligence activities, and understanding regulatory processes for government health care programs like Medicare, Medicaid and Workers Compensation across diverse healthcare care services. The key strengths also include superior written and verbal communications program management and people management skills.EDUCATION:New York University New York, NYRobert F. Wagner Graduate School of Public ServiceMaster of Public Administration, May 2002State University of New York at Albany Albany, NYNelson A. Rockefeller College of Public Affairs and PolicyBachelor of Arts, Magna Cum Laude, May 2000EXPERIENCE2019 - Present2017 2018KPMG, LLP Short Hills, NJManagerConsulting Forensic Practice, Healthcare and Life SciencesDevelop and deliver Healthcare regulatory and compliance service offerings; develop and execute structured detailed work in areas such as compliance assessments, investigations, and operational improvements.Assists with the implementation of compliance work plans for health care organizations seeking to merge with or acquire other healthcare entities to assess potential compliance risks.Conducts HIPAA compliance gap and risk assessments on behalf of a variety of covered entities and business associates. Assists organizations to develop and implement remediation roadmaps to improve privacy controls.Assist with business development efforts; assist with business development initiatives, including the development of proposals.Create a collaborative team environment, foster a common understanding of team objectives, and clearly articulate expectations.Ensure work product and related deliverables are performed in accordance with established standards and engagement requirements to meet client and firm expectations.Lead and participate in people development; coach, mentor staff by imparting knowledge, skills, and experience in attracting and retaining staff.Develop and sustain solid relationships with client personnel and demonstrate the ability to identify additional opportunities with existing clients; identify and communicate technical matters while serving as a liaison to both clients and engagement leadership; participate and/or lead meetings with both clients and the engagement team.Most recent engagements included assessing the privacy program of a large health care system to assess the policies, procedures, process, and controls maintained to address whether the program is meeting key HIPAA regulatory requirements and working within the privacy department of a large Northeastern hospital investigating privacy incidents including potential breaches and reporting to both patients and regulatory agencies.ALVAREZ & MARSAL New York, NYDirector, Health Industry GroupAssist health care industry clients in meeting their strategic, financial, and operational objectives through client facing transactional advisory or operational diligence including assessing the companies compliance policies and procedures to determine the risk profile and whether changes are required.Assess the compliance and quality reviews of health care companies including providers and payers to determine if they meet federal, state, or accreditation guidelines.Provide support for both payers and providers by identifying and addressing reimbursement, policy and regulatory issues within government and private sector health programs and assess whether they need to build more compliance tools to prevent fraud, waste, or abuse.Determine the regulatory and legislative risk for government programs for both new and existing payers or providers nationally and within specific states.Most recent engagement included due diligence activities focused on the potential acquisition of a health care plan by a large integrated health care system. Project management work was managed across A&M, A&Ms client, and the sellers representatives as well as other external advisors (legal). Project analysis work included the assessment of the company and targeted compliance with regulatory requirements including the OIG, and state health care payment and coverage regulations.2012 2017MARWOOD GROUP New York, NYSenior Vice President, Advisory GroupManaged the entire regulatory and legislative diligence project for both buy-side and sell-side health care transactions and communicated directly with private equity and corporate clients.Managed the assessment of target companies clinical compliance and quality assurance processes, including documentation review, surveying management, and overseeing a clinical review of claims and services to determine medical necessity, correct coding, and appropriate care.Developed compliance tools and processes to prevent fraud, waste and abuse and prepared health care companies for federal or state audits as well as surveys and activities in the preparation for accreditation or renewals of certification standards.Developed recommendations for the companies clinical compliance and regulatory areas for potential growth/expansion opportunities.Supervised clinical associates and analyst staff on project work including research, stakeholder correspondence, and final project deliverables.Vice President, Advisory GroupProvided regulatory, reimbursement, state, and federal analysis as part of due diligence process for private equity groups on either the buy-side or sell-side of acquisitions in the health care markets.Performed compliance related activities including documentation reviews, charts audits and senior management interviews for various clients to determine if potential acquisitions were following state and federal requirements to run an effective quality and compliance program.Analyzed and synthesized data collected through research and interviews with various stakeholders to present findings to clients through written assessments of companies clinical and compliance programs.2002 2012U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES New York, NYProgram Analyst, Office of Inspector General (OIG) Office of Evaluation and InspectionsConducted national evaluations of U.S. Department of Health and Human Services programs and policies including using quantitative and qualitative methodologies to assess efficiency and effectiveness of programs and policies.Assessed various policies and programs to determine compliance with OIG standards and requirements including Medicare contractors, Part D plans, pharmacies, etc.Served as a member of an evaluation team responsible for researching program issues, conducting interviews, reviewing documentation, and writing evaluation reports.Crafted recommendations to agencies for policy and program improvement, taxpayer savings, and promoting improved quality of care and services for program beneficiaries.Published Reports include:Medicare Payments for Surgical Debridement Services (OEI-02-05-00390) Part of two-person team that led a national evaluation of the medical necessity of Medicare payments for surgical debridement services. Specifically, looked at whether 5 HCPCS codes that were billed for surgical debridement services in 2004 were medically necessary, correctly coded, and documented appropriately for Medicare. Study identified an estimated $64 million in improper Medicare payments in 2004. Published May 2007Availability of Medicare Part D for Dual-Eligible Nursing Home Residents (OEI-02-06-00190) Part of three-person team that led a national evaluation on the early implementation of the Medicare Part D program in nursing homes. Specifically, assessing the availability of Medicare Part D drugs to dual-eligible nursing home residents. Published June 2008 |
