Plan and manage enterprise-level revenue compliance projects and audits as per the Office of Compliance and Integrity Work and Audit Plan. Conduct chart-to-bills audits in multiple areas. Evaluate processes and controls to ensure accurate charge capture and billing procedures. Monitor and assess risk, and recommend mitigation strategies. Investigate allegations of inappropriate billing activities. Responsible for the integrity of the compliance incident reporting system and investigation database. Train employees and auditors. Monitor federal and state laws and industry regulations and incorporate changes to organizational procedures as necessary. Represent HHC at industry events. Review fraud alerts, regulatory advisories, industry best practices, and enforcement actions.
•Selected as the Regional Innovation Network Coordinator for HHC Primary & Specialty Medical Group.
•Improved compliance by developing and/or updating policies and procedures.
•Reduced risk by creating and deliver

Identified potential fraud, waste, and abuse in the state Medical Assistance Program, using data analytics. Analyze American Medical Association Current Procedural Terminology (CPT), Healthcare Common Procedures Coding Systems (HCPCS), and International Classification of Diseases Tenth Revision (ICD-10) coding. Initiated investigations of medical providers for double billing, upcoding, false claims, unbundling, and Stark Law violations. Determined areas for recouping funds and guide the recovery of overpayments from medical providers. Ascertained gaps in claim edits, policies, and procedures. Reviewed patient documentation for compliance with federal and state regulations. Communicated audit findings to federal and state law enforcement agencies and to senior management. Recommended actions.
•Achieved millions of dollars in savings for the state by eliminating overpayments relating to inefficient practices by the Community Health Network of Connecticut.
•Improved efficiency by develo