Carmen S. Cruz Email & Phone Number

Jacksonville, Fl, Us

Exactech Headquarters, Gainesville, Florida

Engaged in the operation of Exactech’ Compliance and Ethics Program for the Americas Region. Compliance support to Americas on-site reviews and training, assisting in third-party audits, creative problem solving to address the needs of stakeholders, an implementing corrective/preventing action. Responsible for managing the data collection, validation and reporting of all healthcare professional (HCP) aggregate spend reporting required by law and industry ethical codes in the U.S. and other Americas jurisdictions, as applicable. Notable accomplishments to date: . Established a due diligence process for evaluating prospective US agents.. Rolled out due diligence forms and training in Spanish and Portuguese for Americas markets.. Revised the Annual Compliance Training content for US employees and sales agents improving clarity and relevance.

Exactech Headquarters, Gainesville, Florida Area

Support the operation of Exactech’s Compliance and Ethics Program for the United States as well as the Americas Region. Notable accomplishments: . Assessing the existing processes for U.S. Transparency data collection and reporting worked with IT partners to streamline the report generation, collection and review process resulting in increased effectiveness, accuracy, and time savings. . Performed comprehensive due diligence of South America distributor resulting in contract renewal.. Performed compliance program review and provided on-site audit support of Central America distributor.. Led the onboarding and integration with vendor supporting U.S. Transparency and HCP identification activities. . Streamlined assumptions documentation by implementing a dynamic tool to track all aspects of U.S. transparency reporting.. Developed a dynamic monthly report to track Americas Compliance Program work plan activities

Jacksonville, Florida Area

Lead and develop a team of compliance professionals responsible for Medicare Part C and Part D compliance program oversight activities. Provide support to the Vice President/Compliance Officer and the Medicare Compliance Official in the execution of work plan activities. Perform assessment and oversight of risk areas. Develop metrics to track an evaluate performance. Review business processes in order to develop and implement compliance strategies that mitigate risk and ensure compliance with regulatory requirements. Help achieve business goals by providing consultation on Medicare Advantage and Part D laws and regulations in various projects, committees and enterprise initiatives. Key contributions include: Assist in building and developing a corporate Medicare compliance team. Establish processes and controls for the oversight and coordination of all Medicare program administrative functions: certifications and attestations by senior contracting officials, HPMS memos, EPOC, reporting submissions, reviews and audits. Develop a comprehensive Medicare marketing monitoring program, which has increased sales agent compliance and reduced complaints. Conduct investigations to resolve and respond to various escalated client issues. Streamline the general and targeted Medicare compliance training.Structure an independent review of member required materials to improve accuracy.

Jacksonville, Florida Area

Led an operational compliance team of Medicare Advantage and Part D professionals responsible for executing on key Medicare segment product team strategy activities: timely impact analysis of regulatory guidance, coordination and submission of Centers for Medicare and Medicaid Services product application, bid, marketing materials review, development of required member materials. Two key accomplishments during this period involve the end to end review of two areas of customer dissatisfaction and CMS scrutiny: CTM complaints and enrollment related retroactive transactions. The process improvements resulted in overall reduction of the age and volume of the inventory and a sustained long term disciplined approach for performing root cause analysis by our organization.

Bachelor’S Degree, Business Administration And Management, General

Business Communications/Marketing