Streamlining Compliance for Managed Care Organizations
The Challenge
A managed care organization serving Medicaid and Medicare populations, frequently faced rigorous and regular audits from state and federal agencies due to the nature of their service population. These audits required comprehensive evidence of compliance across various departments, including corporate compliance and privacy. The organization's compliance and privacy teams were under constant pressure to provide clear and easily understandable evidence of compliance to auditors.
The Solution
With a background in working for a healthcare regulator, Jessica Zeff, the CEO for Simply Compliance, was uniquely positioned to address these challenges. She led the corporate compliance and privacy teams, leveraging her expertise to gather and present compliance evidence in a manner that was easily comprehensible to auditors.
This included:
Systematic Documentation: Implementing a systematic approach to documentation that ensured all compliance activities were meticulously recorded and easily accessible.
Clear Presentation: Designing presentations and reports that highlighted key compliance metrics and activities, making it straightforward for auditors to assess compliance.
Proactive Communication: Maintaining open lines of communication with auditors to understand their requirements and address any concerns proactively.
The Results
The impact of Jessica's work was significant. When auditors reviewed the compliance and privacy sections, they consistently found the evidence so well-organized and clear that they would often skip her section and move on to other departments. This not only demonstrated the effectiveness of Jessica's compliance strategy but also saved the organization time and resources during audits.
The Conclusion
Jessica Zeff's expertise in compliance and her background in healthcare regulation transformed the audit experience for the managed care organization. Her ability to present clear, comprehensive, and easily understandable evidence of compliance built trust with auditors, streamlined the audit process, and ensured ongoing compliance with state and federal regulations. This case highlights the importance of effective compliance management and the value of having an experienced compliance professional like Jessica leading the way.