Jerry Abrams Email & Phone Number

Leverage extensive experience in creating successful risk management programs and policies to design risk mitigation strategies for HealthPlan Services. Evaluate risk for a substantial number of transactions. Analyze business processes to determine business-driven “risk appetite,” developing reports to document probable risk. Redefine corporate risk objectives, conduct internal and external audits, and issue CAPS for all non-compliant team members.Complete vendor management functions that included vendor onboarding and offboarding, SOW review and implementation, and vendor audits. Serve as a member of the Incident Command SWAT Team for crisis management. Developed and instituted an entire ERM Program from scratch, including the framework and Root Cause Analysis (RCA) framework documentation, strategies, expectations and objectives, mitigation/remediation standards, all SOPs and policies, and Corporate ERM Education initiatives. Designed a Risk Register specifically for the type of entity being evaluated. Facilitated a successful corporate rollout. Created and launched a Crisis Management Office. Built the Crisis Process Framework, instituted policies and SOPs, and wrote crisis management working/reporting documents. Identified working silos and restructured the process to create a fluid workflow. Formed structured schedules for all deliverables in a crisis environment. Designed and implemented vendor management processes, including Monthly Scorecards, Annual Attestations, and Contract Compliance. Designed SharePoint platforms for multiple swim lanes within the organization. Gained deep knowledge in SOX I & II, HiTrust, and PCI certification programs. Re-designed Vendor Management -Process, procedures and methodology GRC Tools (Navex, Radar, and Archer)

Us

Compliance & Regulatory Analyst I provide guidance to business owners related to the requirements of the Florida Medicaid contract as well as state and federal laws that impact the Medicaid Managed Care Organization. I monitor operational processes and procedures to ensure full compliance with HIPAA Privacy and security regulations and corporate policies.1. Issue tract and trend internal warning letters and corrective active plans2. Track issuance of liquidated damages issued by the state of Florida3. Research state regulations in relation to the AHCA contract4. Provide solutions/recommendations to Compliance Director when areas of risk/vulnerabilities have been identified5. Maintain compliance documentation library/repository within SharePoint6. Maintain compliance database with current AHCA contract7. Partners with state Medicaid Program Integrity and assist with Medicaid fraud investigations8. Partners with Florida State Attorney General, Medicaid Fraud Control Unit (MFCU), and assists with Medicaid fraud investigations9. Monitors and manages reporting to to AHCA on average 75 reports per month

 Assisted in the coordination of 1 merger and 4 acquisitions.  Developed and managed a tracking system for 91 entities and 500 client SLA’s. Developed integrated compliance capabilities to better anticipate industry trends, increase efficiency, and participate in the evolution of the company’s core strategies Delivered compliance culture change across diverse corporate levels and teams, training over 300 personnel. Defined and measured Compliance values and managed performance expectations Governed compliance and risk program strategies preventing a loss totaling over $500k. Develop integrated risk strategies and frameworks across compliance, regulatory and technology risk landscape. Manage crisis and remediation through complex and diverse environments. Expert in PEO Licensing requirement.

 Ensure full compliance for the company’s contract with the Department of Children and Family Services (DCF) and Joint Commission (accreditation agency). Analyze policies and provide policy owners with recommendations for updates and improvements. Track laws and regulations affecting facilities requirement. Design and implement programs, policies, and practices to ensure that all departments are in compliance with TJC accreditation standards, HIPAA regulations, and all applicable federal, state and local statutes. Monitor medical records compliance and complete Steton Audit reports as needed.  Analyze indicator reports to track and report trends to executive management in a concise format and a timely manner. Recommended process that improved compliance rate from 19% to current 95%. Recognized by Chief of Security for exemplary efforts in this initiative. Created and deployed 2 different corporate surveys for staff on key areas of safety and process improvement and formed 4 employee teams to address results.  Liaise with risk owners regarding risk management strategies to ensure a risk aware culture • Maintain strategic and operational risk registers • Coordinate regular risk reports to the Board • Secretariat for Risk and Compliance Board subcommittee Manage the policy framework including coordination of the policy library and document control

St. Louis, Mo, Us

 Oversee all quality control operations, including making team assignments, providing support to junior quality control analysts, and completing annual performance reviews. Develop comprehensive quality control requirements and procedures for each project. Maximized quality/reduced costs by maintaining quality control objectives through collaboration with managers. Participated in an analytical method review board, identifying improvements to procedure execution and validation gaps.

St. Louis, Mo, Us

 Built quality program from the ground up, including the development of training guides and SOPs, quality scorecards, and quality guidelines. Trained 300 agents and all new hires that included all supervisors. Coached both agents and supervisors to improve understanding of quality guidelines and expectations. Served as a liaison in a successful quality recovery plan. Created automated evaluation tracking process through link from Excel to SharePoint in order to expedite workflow distribution and ensure client’s contractual compliance. Generated daily reports through Verint, Ceres, and Avaya that provided upper management insight into quality performance. Ensured delivery of over 1,800 evaluations each month for 545 agents; maintained 100% contractual compliance with completed quality evaluations and call reviews.

St. Louis, Mo, Us

 Gained reputation for receiving highest possible client service quality scores and positive client feedback. Additionally, signified as one of 5 team members chosen to participate in a key Operational Improvement Task Force. Recaptured $3 million in potentially lost revenues in 7 months through workflow and process redesign initiatives. Prevented projected loss of $2 million by implementing fail-safe procedures in the event of potential system failures. Consistently surpassed sales performance metrics by over 45%.

Bachelor Of Business Administration (Bba), Risk Management & Business Process Analysis

Computer Operations