Kelleya White Email & Phone Number

Franklin, Tennessee, United States

Greater Nashville Area, Tn

Investigates reported issues and privacy incidents pertaining to compliance, ethics, and privacy incidents.Implementation of applicable laws, regulations, and industry protocols to ensure internal policies and procedures structure is efficient on a market level. Communication of compliance issues, audit findings, risks, remediation plans, policies and analysis for change metrics Market C-suite executives and Board Members. Implementation of the Center of Excellence’ Annual Compliance Week Initiatives for the TN rmarket.Development and implementation of departmental policy and procedures. Conduction of CMS regulated and focus risk audits for the TN market. Collaboration with TN market leads on audit results plan of actions, remediation and implementation of changes.Liaison between Compliance/Legal compliance communications and education to TN market associates (physicians, clinical and non-clinical associates). Champions a culture of inclusivity, diversity with Ascension’s Center of Excellence core values and Saint Thomas’ mission statement. Monitors compliance trends and changes in regulations/jurisdictions as it relates to practices and polices.Implementation of regulated processes such as, Conflicts of Interests and Open Payments (Sunshine Act), Office of Civil Rights Reporting, Non-Monetary Compensation, and Patient Privacy (PHI standards).Maintains knowledge on, DOJ, OIG/GSA, OSHA, NCQA, HIPAA and HITECT regulatory guidance and changes, ensuring Ascensions policies remain in alignment with government standards.

Greater Nashville Area, Tn

Development and implementation of the vendor intake process for all First Tier, Downstream and Related Entities (FDRs).Development of the FDR lifecycle on-boarding and expansion processes with support from Procurement, Information Security, Compliance, etc.Supervision of First Tier, Downstream, and Related Entities (FDRs) onboarding process. Workgroup member of remediation group in the lifting of CMS endowed sanctions of Cigna-HealthSpring.Managed FDR (vendor) strategy and relationships to support alignment with Cigna-HealthSpring’s policies and contractual obligations.Liaison between FDRs and Cigna-HealthSpring stakeholders for policy implementation, audit reviews, risk analysis and other compliance metrics. Review of FDR contractual obligations and collaboration with Legal on oversight of each onboarded and annually reviewed FDR. Reviewed member complaints of FDR inadequacies for remediation and corrective actions.Participated in vendor oversight meetings and activities as Medicare regulatory subject matter expert.Development of department internal website (SharePoint) and dashboard to safeguard competency, provide transparency of audit metrics, trend analysis and other pertinent information for internal stakeholders.

Greater Nashville Area, Tn

Trained new hire Investigation Specialist and Resolution Analyst. Implementation of metric dashboards for analysis of root cause trends, policy changes and risk assessments due to member/provider complaints.Communication of root cause, risk mitigation and corrective actions to Senior leadership, C-Suite Executives and CMS Account Managers.Collaboration with internal Business Owners, CMS Account Managers on implementation of Medicare changes within internal processes and policies. Subject Matter Expert (SME) for Customer Services, Appeals/Grievances and Organization Determination departments, fostering an open and honest culture of networking and communication. Review of Medicare and other regulatory requirements; ensuring timely distribution of guidance and other applicable information for business owners. Conducted high-risk investigations, such as Congressional and HHS initiated complaints. Evaluation of employee performance, creation of individual and team objectives and development plans, , and performed other managerial tasks as needed or required.Contributed to the Compliance Awareness, Training, and Education Program as needed to support continuous learning as well as annual mandatory compliance training requirements.Partnered with managers of other Compliance Program functions, including Auditing and Monitoring, Reporting, and Compliance Program Administration, contributing expertise in these areas to help fulfill overall Program needs and responsibilities.Other related duties as assigned to meet departmental and Company objectives.

Nashville, Tennessee

Investigation of member/provider complaints.Implementation of root cause metrics/trends for Senior Leadership. Liaison between organization and member/providers to create cohesive and open lines of communication. Collaborated with internal departments for research and resolution of investigated issues. Assisted with annual department policy and procedure review.Appointed as Investigations liaison to Government Entity.Subject Matter Expert (SME) for Customer Service and Appeals/Grievances.Workgroup member of annual Member Materials Review.

Greater Nashville Area, Tn

Managed department reorganization for Referrals/Pre-certification Triage team. Gathered initial documentation for member referrals, authorizations, and pre-certifications to be completed by Nursing Unit or Medical Director. Coordinated the work-flow between Clinical and Non-Clinical team members to secure a valid referral was reviewed for patient needs. Set up appointments, coordinated clinic visits, and any special arrangements such as transportation, interpreter services, specialty care, etc. For members. Developed, initiated and maintained policies.Coached all non-clinical new hires on referral/authorization process. Formulated departmental statistical reporting for leadership. Department liaison between team and internal departments on cross-functional projects. Performed other duties as assigned by the manager or Medical Director.

Juris Master, Health Law

Master'S Of Professional Studies, Organizational Leadership

Bachelors, Political Science And Government

Activities and Societies: Nu Vizion Gospel Choir, Political Science Club, Volunteer work with: Habitat for Humanity & African American.