Emily Keane Email & Phone Number

Pittsburgh, Pa, Us

Wheeling, West Virginia, United States

Established, streamlined, and enhanced the audit and advisory function as a collaborative business partner including: • Implemented an annual audit plan including a risk-based approach for Model Audit Rule (MAR).• Develop, documented, and implemented MAR controls to prevent, detect, and mitigate risks.• Coordinated and drove external audit engagements, including but not limited to financial statement audits, SOC 1 Type II reviews, and group customer audits. • In partnership with external auditors, issued two, SOC 1 Type II audit with no findings. • After six months of employment, inherited the payment integrity team and quickly established processes to enhance the payment integrity function and prevent over-payments. • Established a partnership with external third-party partner to increase payment integrity audit savings and recoveries as well as reduced the overall cost of the payment integrity function. • Proactively monitored, researched and assessed laws, regulations, policies, and standards in support of the audit and advisory function.• Coordinated and lead the Financial Examination for The Health Plan in direct collaboration with the West Virginia Office of Insurance Commissioners and third-party auditing firm.

Pittsburgh, Pennsylvania, United States

Dedicated Learning Advisor leading a team of learning advisory consultants, responsible for liaising with the Highmark Health Enterprise multiple operating units in their learning and development needs, wants, and interests. Providing specialized learning consultation focused on infusing learning and development as the catalyst for change. Develop, design and implement Learning and Development annual operating plans, by representing the needs, wants, and interests of enterprise business units through governance.

Greater Pittsburgh Area

Directed the administration and oversight of an effective compliance program, including the Code of Business Conduct, exclusion screening, and investigation of reported integrity and compliance concerns. • Strengthened the effectiveness of the compliance program through the first a risk-based monitoring and auditing of First Tier, Downstream, and Related Entities (FDRs). • Enhanced, systematized, and executed the annual conflict of interest disclosure certification requirements across the enterprise.• Prepared, facilitated, and articulated the required compliance program documentation to external examiners, customers, and partner plans to fulfill contractual obligations.• Performed confidential investigations with integrity and empathy, in partnership with human resources, to resolve potential conflicts of interest, compliance violations in support of the Code of Conduct and Core Behaviors. • Identified, oversaw, and negotiated contract reviews across the enterprise to comply with federal and state regulations.• Streamlined the Delegated Advisory Committee (DAC) to simplify the compliance and regulatory requirements for business owners.• Delivered ongoing interpretation, guidance, and oversight to business areas to ensure compliance with the Violent Crime Control and Law Enforcement Act (VCCA). • Monitored, analyzed, and advised business owners of key activities required for a successful implementation of the Blue Cross Blue Shield Association (BCBSA), state, and federal mandates compliance requirements.• Initiated and lead the office of civil rights hotline and facilitated the investigation and resolution of potential discrimination allegations in collaboration with the Office of Civil Rights. • Integrated compliance program requirements into the Highmark Health Data Governance model to optimize business outcomes and reduce contracting times.

Greater Pittsburgh Area