Kimberly Collins
Sparta
Summary
Lead compliance audits and develop corrective action plans that align with regulatory standards. Collaborate with cross-functional teams to enhance compliance strategies and improve operational performance. Utilize extensive knowledge of healthcare regulations to mitigate risks and ensure adherence to state and federal guidelines.
Overview
27
27
years of professional experience
Work History
Compliance Consultant
Optum Insight
06.2022 - Current
- Lead audits to assess compliance with client policies and federal and state regulations.
- Develop, implement and follow up on corrective action plans based on audit findings.
- Collaborate with cross-functional teams to enhance compliance strategies.
- Validated audits, compiled summaries, provided written action plans and presented to senior management.
- Evaluate and enhance compliance program objectives and deliverables on an ongoing basis.
- Provide practical, solutions-oriented compliance guidance to stakeholders.
- Identify and escalate risks, issues, and concerns, and support remediation efforts.
- Excellent analytical, organizational, and problem-solving skills
Compliance Consultant
Pantheon Global Holdings
05.2019 - 06.2022
- Conducted monitoring of regulatory changes published by various agencies and provided education on the changes, including recommended implementation plans.
- Developed policy and procedures based on analytical findings.
- Oversight of daily audit activities and audit team.
- Validated audits, compiled summaries, provided written action plans and presented to senior management.
- Research and resolve claim statuses across major payers, understanding why a claim was denied and what the correct path forward is.
- Monitor and assess regulatory changes impacting health plans and reimbursement.
- Proven ability to manage multiple priorities and deadlines
Medicare/Medicaid Fraud Investigator
Advance Med
10.2015 - 05.2018
- Performed investigation and monitoring of provider billing through onsite and desk audits, data analysis, medical records review, to detect potential fraud, waste and abusive behavior.
- Compile data into written reports: collect, utilize & interpret data obtained from a variety of reports and other sources, thereby identifying & documenting questionable patterns related to operation, and other practices.
- Provided recommended corrective actions based on audit findings and regulatory requirements.
- Conducted regulatory driven risk assessments to identify potential audit focus areas.
- Performed data analytics and visualization to track and trend provider and member inquiries, concerns, complaints and appeals.
- Referred substantiated cases of fraud or abusive behavior to the appropriate regulatory agency with written summaries of the audit or investigation findings and analytic trending of their billing practices.
- Developed and administered provider education focusing on fraud, waste and abuse; appropriate billing practices; and other provider education topics based on the audit or investigation findings.
- Participated in State Medicaid/Medicare task force meetings.
Corporate Compliance Coordinator
Inogen, Inc.
03.2013 - 10.2015
- Coordinated the response to corporate Internal Audit requests to ensure accurate and timely response by various service teams.
- Oversaw all external audit responses to federal regulatory agencies and Medicare Administrative Contractors (MACs).
- Organized the implementation of corrective actions as a result of audit activity and ensured implementation of all process improvements.
- Support and / or lead targeted compliance audits and assessments.
- Assist in developing controls, KPIs, and monitoring tied to compliance and revenue cycle performance.
Corporate Compliance
DME of TN
09.2010 - 08.2012
- Responsible for managing the continuous risk assessment process to identify areas of potential process vulnerability for inclusion on the audit workplan.
- Managed the annual completion of the Internal Audit workplan consisting of regulatory, Medicare billing and accounting procedural audits.
- Oversaw the credit balance resolution process, including validation of credit balance sources and accuracy of resolution.
- Oversaw all Government audit responses, including managing the appeals process at the fair hearing and Administrative Law Judge (ALJ) levels.
- Oversaw the quality of reported audit results from staff auditors and ensured that follow-up was conducted timely and accurately on all audit corrective actions.
- Served as a Subject Matter Expert for Senior Leadership and the Compliance Officer with regards to federal regulations and billing standards.
- Provided quarterly in-service training to staff on high-risk topics.
- Also served as the Interim Manager for Customer Service during a position vacancy.
Lead Compliance/Reimbursement Internal Auditor
American HomePatient
03.2002 - 09.2010
- Audited national Billing Center claims accuracy for compliance with Medicare and company policies and procedures.
- Audited credit balance resolution to ensure that credit balances were resolved timely and accurately.
- Assumed the Lead Auditor role for all audits and oversaw departmental quality.
- Educated Billing Centers on Medicare Regulations when needed according to audit findings.
- Wrote all training material for use by field and internal auditors, including the 'Field Internal and External Audit procedure manual' and the 'Corporate Internal Audit Work Process Instructions'.
- Responsible for assisting both KPMG and LBMC with external audit assistance.
- Continuously developed and maintained my knowledge of state and federal regulations, industry standards and organizational policy related to Compliance, Reimbursement and Operational areas of the industry.
Customer Service / Quality Assurance Associate
American HomePatient
08.1999 - 03.2002
- Managed new and recurring enteral patient accounts, ensuring 100% compliance with enteral billing practices.
- Oversaw open order reports and credit balances for 7 locations, ensuring accuracy and compliance.
- Audited all paperwork prior to being sent to the Billing Center for accuracy with federal guidelines, payer requirements and company standards.
- Developed and delivered training programs on DME billing, CMN/Order Management, and regulatory requirements for Customer Service and Billing staff.
- Onboarded new corporate internal auditors to familiarize them with service delivery practices.
- Reduced held revenue by $462,000 across 7 branches.
Education
B.S - Interdisciplinary Studies
Tennessee State University
TN, USA01-2010
Skills
- Regulatory compliance
- Compliance auditing
- Compliance monitoring
- Health Information Management
- MS Office Products Billing
- Hospital Revenue Cycle
- Physician Practice Revenue Cycle
- Claims Processing
- Audit management
- Audit processes
- Documentation review
- Data Analysis
- Regulatory Documentation
- Regulatory Investigations
- Internal controls
- Remediation Strategies
- Policy development
- SOP creation
- Operational effectiveness
- Policy Review
- Incident Reporting
- Field Assessments
- Compliance Support
- Compliance Operations
- Compliance Projects
- Project oversight
- Compliance
- EPIC
- Cross-functional teamwork
- Cross-Functional Leadership
- Effective communication
- Problem solving
- Attention to detail
- Analytical thinking
- Action planning
- Adaptability
- Document management
- Data Review
- Audit Reporting
- Client Engagement
- Operational effectiveness
- Compliance Projects
- Adaptability
Timeline
Compliance Consultant
Optum Insight
06.2022 - Current
Compliance Consultant
Pantheon Global Holdings
05.2019 - 06.2022
Medicare/Medicaid Fraud Investigator
Advance Med
10.2015 - 05.2018
Corporate Compliance Coordinator
Inogen, Inc.
03.2013 - 10.2015
Corporate Compliance
DME of TN
09.2010 - 08.2012
Lead Compliance/Reimbursement Internal Auditor
American HomePatient
03.2002 - 09.2010
Customer Service / Quality Assurance Associate
American HomePatient
08.1999 - 03.2002
B.S - Interdisciplinary Studies
Tennessee State University