• Compliance Leadership: Serve as Fractional Compliance Officer or Executive Consultant for managed care plans (Medicare and D-SNPs) and other healthcare entities; develop compliance strategy to support organizational objectives and regulatory requirements; manage/train compliance staff; participate in/prepare presentations for compliance, audit committee, and board
meetings.
• Enterprise Risk Mitigation & Governance: Oversee internal audits; compliance, privacy and security assessments; special investigations to address potential program integrity and internal control issues and ensure adherence to required protocols.
• Project Management Leadership: Develop and manage detailed project plans, timelines, and cross-functional to ensure timely and successful implementation of regulatory mandates (Medicare, Medicaid), IT Security initiatives (Identity and Access
Management, HITRUST, NIST Cybersecurity, and SOC2) and audit readiness plans.
• Liaison Between Managed Care Plan & CMS: Se

(TMG Health was acquired by Cognizant Technology Solutions in Aug '17) SVP/Chief Compliance and Privacy Officer/Chief Audit Executive
• Enterprise-Wide Risk Leadership: Oversaw compliance, ethics, privacy, internal audit, and IT security staff for healthcare
segment supporting 16 national health plan clients, managing 4.3 million members across all 50 states and offshore operations in India and the Philippines.
• Audit Oversight: Designed and supervised comprehensive internal audit programs and delegation oversight assessments to ensure compliance with regulatory and contractual requirements, IT security standards, HIPAA privacy and security rule, and OIG exclusion criteria.
• Governance and Risk Reporting: Developed compliance and audit dashboard and key performance indicators to deliver actionable insights, support accountability, monitor risks, and offer strategic risk mitigation solutions to the Board of Directors and Audit & Compliance Committees.
• Contract Reviews: Reviewed

• Oversight of Compliance and Quality Management: Directed Compliance, Privacy, Internal Audit, and Quality functions for a national durable medical equipment (DME) and retail pharmacy/mail-order provider, delivering regulatory compliance support to over 200K patients nationwide.
• Strategic Compliance Program Improvement: Enhanced compliance program effectiveness through the development of the
company's first Internal Audit program and Special Investigation Unit (SIU) and led a corporate initiative that reduced Medicare audit denial rates by 20% annually.
• Licensure and Regulatory Management: Oversaw all DME and Pharmacy licensure applications and renewals, liaising with State Boards of Pharmacy, State Medicaid Programs, and Medicare to ensure timely and accurate filings.
• Acquisition Due Diligence Support: Conducted due diligence for potential acquisitions, providing regulatory and operational insights that supported strategic decision-making by the parent company.

• Enterprise Risk and Compliance Leadership: Directed Medicare compliance, internal audit, and delegation oversight functions, ensuring adherence to Medicare, regulatory, and contractual requirements, and optimizing organizational performance.
• Performance Monitoring: Oversaw Medicare Star Ratings Program and related initiatives that resulted in improvement from 3.5 to 4 stars; led health plan leadership discussions to provide feedback on existing strategies, quality and performance results, and member outcomes.
• CMS Audit Leadership and Regulatory Excellence: Led CMS audits and audit readiness initiatives, regulatory responses, and the development and oversight of corrective action plans (CAPs) to address audit findings.
• Compliance Training and Process Optimization: Developed and implemented comprehensive compliance and FWA training programs, revamped policies and procedures, and standardized processes to enhance compliance with Medicare regulations.
• Audit Oversight: Establi

• Risk Management Leadership and Audit Program Enhancement: Restructured the internal audit program, refined the annual audit plan, and oversaw recruitment and training of new audit staff.
• Enterprise-Wide Risk Assessment Strategy: Developed and implemented a comprehensive risk assessment tool, incorporating COBIT and IIA frameworks to support the annual audit planning process for the parent company and subsidiaries.
• Audit Reporting and Operational Optimization: Delivered audit findings and process improvement recommendations to the Audit and Compliance Committee and executive leadership, driving strategic operational enhancements and risk mitigation initiatives.
• Cross-Functional Governance and Committee Leadership: Served as an executive member Healthcare Reform, Medicare Part D, and Risk & Security Oversight committees supporting enterprise governance and adherence to regulatory requirements.
• Strategic Advisory for Regulatory and Operational Initiatives: Provided advisory

Leadership & Training: Supervised and mentored senior and staff auditors, fostering professional development and ensuring high-quality audit execution.
Risk-Based Audit Strategy: Conducted annual risk assessments, identifying key operational, compliance, forensic, and financial risks to develop targeted audit plans and procedures.
Audit Execution & Reporting: Led and executed audits, communicated findings to senior management, and presented comprehensive reports to the Audit and Compliance Committee Board to drive informed decision-making.
Regulatory Compliance & Governance: Managed public records requests in compliance with Florida Statute Chapter 119, ensuring transparency and adherence to state regulations.