Eva Legall, Mba, Cia, Chc Email & Phone Number

Lakeland, Fl, Us

New York, United States

Led a diverse team of auditors in risk assessment, process enhancement, and operational audit completion, ensuring compliance standards were met. Performed Revenue Cycle Auditing to address any issues and optimize revenue efficiencies. Presented findings and recommendations to senior leadership and collaborated cross-functionally to drive efficiencies and foster trust. Directed annual risk assessment processes, formulated comprehensive audit work plans, assumed leadership for the annual MAR & CMS Compliance Program Effectiveness audits.

Greater New York City Area

Collaborated with the Chief Compliance Officer to develop the annual work plan, aligning audit activities with company objectives. Managed comprehensive audits of internal operations and delegated entities, ensuring strict adherence to compliance standards. Performed Revenue Cycle Management audits to align with regulatory and contractual compliance. Delivered tailored compliance training to new hires and provided targeted coaching to mitigate risk and foster a culture of compliance across the organization.

Greater New York City Area

Managed oversight of diverse entities, including Medicare Delegated Entities and Medicaid Subcontractors across multiple services, conducting annual risk assessments to ensure focused and effective audit coverage. Monitored monthly reports to ensure compliance with KPIs and SLAs outlined in provider agreements.

Greater New York City Area

Conducted thorough audits in adherence to Institute of Internal Auditors (IIA) guidelines, ensuring the highest standards of quality and integrity were met. Delivered detailed audit reports, showcasing findings and actionable recommendations to the Audit Committee, while also providing supervision, training, and support for staff auditors in report writing.

Greater New York City Area

Conducted in-depth claim reviews to enhance operational and financial efficiencies, utilizing advanced analytical tools to pinpoint areas of significant impact and identify potential control deficiencies. Delivered valuable recommendations to proactively mitigate risks and enhance processes, leading to notable reductions in both risk exposure and overall operational expenses.

Greater New York City Area

Negotiated contract rates with diverse healthcare providers, strengthening the company's network across various sectors including physicians, dialysis centers, and homecare facilities. Collaborated with cross-functional teams to address operational issues impacting contract negotiations and implementation, while also conducting site visits to educate provider staff on policy changes for timely communication and compliance.

Greater New York City Area

Led provider recruitment efforts for PPO, HMO, and government program networks, while conducting on-site visits to ensure providers were informed of policy changes and to resolve contractual issues. Fostered collaboration across multiple departments to address provider concerns and enhance overall provider satisfaction through proactive measures.

Greater New York City Area

Managed online Rate, Diagnosis, CPT Crosswalk, and Procedure files, ensuring accuracy and accessibility. Developed annual rates for CPT codes utilizing approved methodologies, researched procedural nomenclature allowances from reputable sources like HIAA and RBRVS to create in-network fee schedules.

Master Of Business Administration (Mba), Business Administration And Management, General

Bachelor Of Science (Bs), Health Services Administration