What are your responsibilities as the Senior Manager of Compliance at andros?
As the Senior Compliance Manager at andros I am responsible for on-going compliance throughout the organization. I lead the delegated audit programs for our clients as well as internal audits. Compliance, as a team, is a resource for our clients as well as internally. Compliance is responsible for ensuring internal and external stakeholders are aware of, and adhering to, any new standards from NCQA, states, and federal regulations. Part of this responsibility includes timely updates to policies, products, and processes.
What are the most common healthcare compliance issues you address and what can organizations do to avoid them?
Per CMS, Credentialing and Network Development can be considered a high risk area in healthcare. It is important to keep up to date on standards and regulations and to continuously audit to ensure adherence. Audits are important because they help identify where there is either a gap in your process or a potential risk that needs to be reviewed and evaluated. Compliance is everyone’s job within an organization.
How do you stay updated with the ever-changing regulations and policies in the healthcare industry?
Since regulations are ever-changing I am a member of New York State Association of Medical Staff Services (NYSAMSS) and National Association of Medical Staff Services (NAMSS). NCQA releases updated standards annually so I make sure to review them once they become available. In addition, I subscribe to various industry newsletters.
How has your expertise benefited andros in terms of compliance and client relationships?
The Compliance team has been a great resource for our clients. We help new clients establish and implement their policies and procedures. Through this process, we build trust with our clients, and help ensure they stay compliant with NCQA, state and federal regulations.
Collaboration and communication are crucial in managing compliance. Can you describe your experience working with different departments and internal or external partners to ensure compliance objectives are met?
It is important to be an excellent listener, coach, and teacher when it comes to meeting with internal and external stakeholders. This is the key to obtaining alignment and buy-in. I also focus on making sure the appropriate stakeholders are involved from the beginning and ensure everyone’s point of view is heard. This, along with process simplicity, are the keys to making sure processes, policies and credentialing files are compliant.
In your view, what are some emerging compliance trends or challenges in the healthcare industry? How do you stay ahead of these trends and proactively address potential compliance issues?
One of the challenges, but also opportunities, is the drive to complete provider onboarding more quickly. Historically, the credentialing process has been time consuming, and in large part a significant point of abrasion with provider partners. I mention this because I focus not only on being an expert in compliance policy, but also a partner to our product and operations teams to ensure we bring new and innovative approaches to the market that are compliant.
Finally, can you provide an example of a successful compliance initiative or project that you have led? What was your role in the project, and what were the outcomes or benefits for the organization?
I created the delegation audit program at andros. I was the lead and created the audit tool, template, and built an internal database to help track audits. Since audits need to be performed annually, we needed a way to track and make sure they are completed on time. The audit tool was built off of NCQA standards and client needs. This program has been a great success and a benefit to our clients.