Tonja H. Email & Phone Number

Texas, United States

Assist with implementing the Medicare Compliance Plan and the Marketing Material Review Process:• Ensure the company’s compliance with laws, rules and regulations relating MA, PDP and Medicare Supplement health insurance products, including Centers for Medicare and Medicaid Services (CMS) and state departments of insurance regulations.• Keep abreast of laws, rules and regulations relating to Medicare and their impact on the company’s business.• Assist with training, rules, regulations and company policies related to the company’s Medicare related business.• Review marketing processes and material for compliance with Medicare laws and regulations.• Facilitate cross-functional teams to develop and implement processes consistent with plan sponsor and regulatory requirements.• Work closely with plan sponsors and business leaders on complex issues relating to aspects of the company’s Medicare related business.

Plano, Texas, United States

Responsible for collaborating with clinical leaders, and frontline staff for the purpose of improving patient safety and reducing patient harm/errors which requires the systematic implementation of effective, reliable care practices, developing an appropriate institutional patient safety culture:• Identified potential risks to help ensure a safe environment and promote the safety and quality of care provided• Maintained incident tracking including leading investigations, assigning tasks, and determining severity• Collected and analyzed data for quality assurance and performance improvement (QAPI) reviews• Collaborated daily with leadership to identify opportunities for improvement based on data analysis• Guided the implementation of performance improvement initiatives corrective actions from survey findings• Conducted patient safety data analysis trending and monthly required reporting

Texas, United States

Worked with corporate and legal teams to determine strategic training plans to meet the needs of the business and drive objectives:• Managed the Acceptable Use Policy with more than 1,200 team members in 23 countries• Created policies, training files and documentation for legal purposes related to the IT Department• Evaluated the Company’s systems of internal control and quality standards• Assisted the global team with the Code of Business Conduct, Compliance Week and Investigations• Implemented the Global Ethics and Compliance New Hire Orientation and updated the intranet page• Provided detailed and timely status reporting to all management as requested

Dallas, Texas, United States

Supported business units in interpretation of regulations related to investigations as well as provided assistance in developing appropriate tools to ensure compliance:• Reviewed compliance-related education and training materials for investigations team• Worked with data analytics to identify patterns of potential fraud, waste, and abuse.• Maintained compliance database to ensure records are accurate and complete• Prepared evidence to establish clear and concise findings to facilitate decision-making• Assisted with interviews and documents discussions in a reliable and consistent fashion• Identified and researched gaps in documentation or potential areas of non-compliance

Dallas, Texas, United States

Served as a company-wide resource and liaison on policies, communications, workflow, quality improvement initiatives and worked with internal functional areas to provide advice; identify, analyze, and mitigate risks, ensure appropriate/adequate training, and support adherence to policies/procedures relating to compliance matters:• Coordinated cross-functional meetings to meet business objectives • Responded to requests for information required by the organization for its regulatory filings• Monitored federal and state laws related to the Health Plan that impacted the organization• Assisted management with interim health plan compliance officer responsibilities• Provided oversight and managed the company’s policies and procedures • Audited risk assessments and tracked completion rates to ensure completion of attestation forms

Mckinney, Tx

Managed communications, data collection and submission of materials for external reviews and audit requests as required:• Audited bank employee workstations and other shared spaces from BOA floor maps • Provided leadership and effectively communicated project status to all stakeholders• Ensured confidential information was protected and secured per Bank of America policies• Analyzed unethical situations and implemented solutions to address workplace issues• Managed audits at local banks and call center and submitted daily reports to management • Skilled to work independently and managing multiple projects

Richardson, Tx

Enhanced components to present relevant compliance topics and training materials to a growing organization: • Delivered new employee and computer-based training to over 18,000 employees annually • Reviewed and updated annual and new hire compliance and regulatory training to HCSC workforce• Designed a comprehensive, year-round ethics campaign and events strategy • Developed ethical campaigns; leadership management tool kits, monitor slides and newsletters• Created the Blue Cross Compliance Ambassador Program in over twenty locations• Retained overall responsibility for maintaining the training, education and communication program