Sabina Gurung, Mph Email & Phone Number

San Francisco, California, United States

The Regulatory Affairs and Compliance Manager is responsible for ensuring On Lok Senior Health Services remains compliant with the regulatory, licensing, and contractual requirements set forth by the Centers for Medicare and Medicaid Services (CMS), the California Department of Health Care Services (DHCS), and other regulatory agencies. The Regulatory Affairs and Compliance Manager performs regulatory compliance activities and implements monitoring initiatives related to the Program of All-Inclusive Care for the Elderly (PACE).

Alameda, California, United States

• Identify and develop Alliance policies and procedures with strong working knowledge of policy development and administration. • Collaborate with senior level staff in analyzing regulatory guidance, policy administration and government affairs.• Oversee, cultivate and manage relationships with local, state, and federal government partners, Associations and downstream representatives.• Facilitate and monitor interactions with representatives from local, state, federal, Association partnerships and downstream representatives on present and pending legislation and healthcare policy.• Create data and summary reports to present to management and committees of upcoming rules, regulations and healthcare policy.• Track policy and legislative work through the legislative process and disseminate key information across the enterprise.• Consult in the development and monitoring of corrective action plans as they pertain to industry outlook and plan perspective. • Prepare and submit routine regulatory reports and analysis to include, but not limited to, Department of Health Care Services (DHCS); Department of Managed Health Care (DMHC); the California Department of Public Health(CDPH); Centers for Medicare and Medicaid Services (CMS)• Conduct learning and education sessions and lead workgroups on policy forecasts and legislative outlook, as necessary.• Train and assist various departments in developing best practices and provides guidance on legislative impact to existing and prospective programs, processes and procedures.• Monitor the regulatory/compliance climate and escalate issues when necessary.

Oklahoma City, Oklahoma Area

• Developed and assessed compliance programs, constructed monitoring and auditing programs, and supported internal risk assessments and/or investigations.• Conducted staff training on services provided to children and young adults with mental and physical health problems.• Participated in the development of presentations or reports to managerial audiences.• Developed and implemented mental health education online training system for new hires. • Trained over 1500 health care staff over the period of 4.5 years. • Demonstrated knowledge of Patient Protection and Affordable Care Act (PPACA), Program Compliance Oversight Group (PCOG), Data Validation, Audit Compliance Monitoring Programs, and Medical Affairs & Clinical Compliance• Audited compliance of health care providers under all laws, regulations, and policies. • Experience leading and consulting with multiple stakeholders and community mental health agencies for collaborative problem solving, decision making and evaluation. • Provided and coordinated wrap 101, wrap 401 and Behavioral Health Aid (BHA) training, coaching, technical assistance and consultation to contracted programs. • Demonstrated knowledge of behavior change, adult learning, motivational interview and their applications. • Monitored contracted programs through record reviews, on-site visits, data collection, budget reviews, and information gathering to guide the team productivity and performance. • Developed coaching plans with community mental health agencies to identify key issues and establish team negotiation to work as a facilitator to solve the problem by applying cultural competence for diverse communities. • Partnered with providers to plan, develop and implement the wraparound process to ensure fidelity to the wraparound model. • Assisted in building collaborative relationships between ODMHSAS, state agencies, multiple stakeholders, other organizations and contract providers.

Oklahoma City, Oklahoma Area

• Monitored documentation compliance with Red Rock policies and procedures and external funding and regulatory agencies.• Assured clinical charts were reviewed and in compliance with accreditation guidelines and funding source requirements.• Trained over 1200 staff over the period of 3 years to improve mental health care efficiency.• Audited over 3000 clinical charts to advance the quality of health care. • Developed and implemented a case-management training module.• Notified staff of compliance issues.• Maintained up to date knowledge of compliance requirement and standards.• Conducted chart reviews on therapeutic programs as assigned.• Trained employees in non-compliance issues.• Conduced follow-up reviews of deficiencies to ensure corrections are in place. • Monitored and ensured clinical records meet criteria for outside audits. • Monitored that quality care actions plans are implemented.• Travelled to all Red Rock BHS sides to ensure agency wide compliance.

Ouhsc

• Conducted research related to an autoimmune disease, Thrombocytopenia under the supervision of Dr. James George in the department of Biostatistics & Epidemiology, College of Public Health.• Collected and processed patient blood samples for research purpose.• Analyzed datasets compiled from patients using statistical tools for presentation.• Constructed graph to compare special cases data• Entered data for all the pertaining patients • Performed literature search to fill patient resource for the TTP website• Worked in the lab- spinning blood, making, arranging and shipping samples• Scheduled, prepared, and assisted with patients visitation• Maintained and arranged patient records for audits, retrieval, review and research purposes

Clinton, Oklahoma

Abstracted medical records with ICD-9-CM, CPT, and DRG coding using 3M.Prepared for JCAHO audits.Assisted in Release of Information, Assembly and Analysis.Filed heavy volume of medical records.Assisted in answering telephones, copying and faxing.

Bachelor Of Science, Health Information Management

Activities and Societies: •Southwestern International Student Association (SISA), 2006 to 2008-Secretary •Student Government Senator 2007.

Master, Public Health

Activities and Societies: •Second place at OU Got Talent-Fund raising event for FAITH Kid (cancer patient)•International Student.