Professional Summary: * Bilingual (Spanish and English) business expert with more than 12 years of progressive experience in development and oversight of healthcare programs, policies, and initiatives to promote growth and achievement in the field. Areas of Expertise: * Cross-Functional Team Leadership (10+ years) * Data Analysis * Relationship Building * Critical Thinking and creative problem solving skills * Regulatory Compliance * Confidentiality/HIPPA * Strategic Planning * Healthcare Management * Medical Coding * Experience with using Microsoft Word (create professional communication and documents) * Advanced knowledge of MS Office automation (VBA, Excel Macros, create spreadsheets, use of formulas, sort and filter data, etc) * Auditing Standards experience - big consulting group audit experience. Career/Work Experience Compliance Auditor SIU Manager 2014 - 2018 AHF MCO of Florida, Fort Lauderdale, Florida Elevate functionality of the organization by meeting all regulatory and departmental deadlines, attending state/federal contract meetings, developing audit rules/queries to pull data for potential FWA activity, responding to detected offenses/corrective actions, facilitating specialized education and training concerning compliance responsibilities, and by recommending policy, procedural, and system changes to enhance investigative outcomes. Selected Accomplishments: * Creator of an Anti-Fraud program that responds to inquiries concerning compliance/non-compliance (NCQA, FDR), internal audits/risk assessments monitoring programs to ensure correct processes are established, and the Special Investigation Unit's policies and procedures that serve as a process expert for fraud, waste, and abuse investigations/financial recoveries. * Independently deliver leadership and job training for compliance functions, and serve as a resource to multiple departments, CO and VP of Operations new investigators, and health plans on compliance issues, including budgeting for activities related to implementation of the Compliance Plan. * Collaborate with executive leadership to develop and implement the company's standards of conduct, related policies and procedures, and enforce/discipline instances of non-compliance. * Curate audits that correlate with audit plans and OIG Guidance for Medicare, Medicaid, and other third-party payer documentation pertaining to FWA, coding, billing, documentation, reimbursement, and privacy activities exhibit knowledge of Medicare (Parts A, B, C and D), Medicaid regulations, and compliance monitoring activities. * Catalyst for positive organizational growth by investigating cases of fraud, waste, and abuse, utilizing data analysis/the Delegation Oversight Review Committee and Credentialing Committee, and through guiding the Special Investigations Unit (FL-SIU).

Highlights:

• Audit
• Coding
• Documentation
• Compliance
• Management
• Medicare
• Health Insurance Portability And Accountability Act
• Security
• Assessments
• Billing
• healthcare
• physical therapist
• physical therapy
• Leadership
• Critical thinking
• Excel