SUMMARY:

Results oriented professional with expertise in operational risk, compliance and audit. Exceptional project management experience, proven ability to build strong relationships with staff and clients using negotiation talent, persuasion and demonstrated commitment. Strong leader creating cohesive teams that produce results above individual ability, consistently surpassing the clients’ expectation. A self - motivated and analytical thinker, consistently pursuing new challenges to stretch my abilities and expand my knowledge.

PROFESSIONAL EXPERIENCE:

Confidential, Eden Prairie, Minnesota

Responsibilities:

• Serving as a HealthCare Compliance Officer in an IT environment, ensuring standards for HIPAA
• Privacy and compliance policies are developed, implemented and administered to monitor ensure the appropriate use of data within the custody of Confidential .
• Leads the Data Governance Compliance Council providing due diligence for compliance activities, and tactical support to Business area Leadership.
• Experience leading process improvement initiatives to increase overall efficiency and productivity.
• Responsible for communicating with internal stakeholders regarding regulatory requirements as they impact business development programs.
• Medicaid and Medicare experience
• Leads initiatives to enhance existing processes and procedure and/or develops new processes and procedures to improve data management efficiency and productivity.
• Conducted high-profile or complicated investigations to ensure all relevant facts are determined and considered; maintain confidentiality and trust around sensitive compliance issues; treat all interviewees with the highest respect and dignity regardless of the circumstances or allegations
• Collaborates with the market segment pillars to identify opportunities to combine existing data assets to create new value for customers through reporting
• Documents data governance policies and procedures and reviews reference tools for downstream stakeholders consultations
• Accessing how well all data maintenance and governance services are being delivered according to all established service level agreements
• Responsible for ensuring the team is organized and prepared for audits and meets audit requirements
• Established parameters for tracking data use and rights monitoring, reporting and audit

Confidential, Franklin Lakes, New Jersey

Senior Compliance Manager

Responsibilities:

• Leads business activity reviews to ensure regulatory compliance in the mail order Pharmacy discipline
• Develops and implements policies and procedures that define ethics and compliance standards, provides compliance training, audits and monitors, facilitates internal reporting, and conducts compliance-related investigations
• Strong analytical skills to interpret regulatory data and make critical decisions.
• Coordinate the development/implementation of work force compliance programs
• Develop education programs for employees, as appropriate, and facilitates communication to maintain awareness of the compliance programs.
• Develop and implement plans for corporate regulatory policies and procedures
• Medicaid and Medicare experience
• Direct investigations of suspected violations of the Code of Conduct or violations of law, under the general direction of the General Counsel
• Regularly conducts and oversees compliance audits and risk assessments and refines program to address significant risks.
• Developed a Foreign Corrupt Practices Compliance Program-
• Organizational communications manager responsible for developing and executing key elements of communications strategy that ensures ongoing, consistent internal communication that aligns employees behind business strategies and builds strong engagement.
• Manage intranet site publication, development and broad-scale to all companies within the Confidential organization
• Administration of large research and development contracts includes assuring that all terms and conditions of the contract are met, negotiation and updating contract provisions asneeded, negotiating performance objectives and measures, and evaluating contractor performance.

Confidential, Cranford, New Jersey

V.P. Compliance and Operational Risk

Responsibilities:

• Responsible for the mitigation of operational, financial, regulatory and reputation risk for the Commercial insurance brokerage operation. i.e. Commercial: Employee Benefits, Property and Casualty Insurance
• Leads the communication process and content of training material to ensure an ethical culture
• Investigated Property and Casualty Insurance claims to determine the extent of liability and or negligence of the insured
• Introduced RCSA Risk Control Self-assessment methodology to the division
• Negotiated with the Department of Insurance on behalf of the Insurance brokerage
• The initial point of contact for guidance in the request for proposal process, provided assistance in gathering company information required as a part of the RFP response
• Streamlined and improved the due diligence processes for carriers, third party vendors and other outside marketers wanting to become a business partner
• Audited standard operating procedures to ensure processes are in compliance with the Bank of America standards Focused on compliance audits relating to Sarbanes Oxley, Anti-Money Laundering (AML) Controls and compliance with the Bank Secrecy Act, KYC and USA Patriot Act. Responsible for "Know Your Customer", Suspicious Activity Reporting, Account Monitoring, Client Documentation and OFAC processes
• Created a line of business dash board of key leading indicators for operational risk that communicated issues regarding work flow concerns in the back office
• Developed Standard Operating Procedures (SOP) and work plans for key risk management projects
• Accessed and monitored risk by facilitating risk assessments within the line of business
• Responsible for Data management Reporting and Analysis: Summarizing audit results and key risk indicator findings, communicated results, milestones and recommendations based upon analysis

Confidential, Jersey City, New Jersey

Regional Director: Operations: Risk Management

Responsibilities:

• Directed, supervised and developed the Regional Data Management staff in gathering sensitive data for Doctors and Plan participants joining the Confidential Health Care network
• Ensures credentialing documentation is current and accurate
• My team consisted of 5 project leaders and 50 Data analyst for Tri State and Ohio Valley regions.
• Improved Confidential ’s customer service position in the market place by reducing the transactions on hand count (3000 transactions to 700, a reduction of 80% in a six-week period
• Worked closely with Quality Control to ensure accurate contract setup, 50% zero defect, 90% zero critical defect
• Ensured compliance through state, federal and corporate regulatory requirements
• Audited all applicable control processes to ensure quality control
• Negotiated the development and ensured compliance with the departmental budget
• Successfully hired key talent and developed retention strategies
• Established rewards and recognition criteria for employee incentives

Confidential, Newark, New Jersey

Director: Technology Project Manager

Responsibilities:

• Planned, directed, and coordinated activities of 20 project teams through the SDLC for system development and product implementation
• Coordinated the development of the Project Office at Check free
• Managed five Junior Project Managers facilitated PMI and ISO methodologies
• Reviewed status reports prepared by project members and prepared final report for management
• Established work plan and staffing for each phase of a project
• Responsible for (COBIT) Control Objectives for Information and related Technology
• Conducted Risk assessment to benchmark IT process performance and capability, expressed as maturity models.
• Helped to meet regulatory requirements by being consistent with generally accepted corporate governance standards (COSO)
• Coached project teams and managers for optimal performance
• Managed Speed to market and budget constraints
• Responsible for performance evaluations