Angela Speck

Experience

• 

  Health Net Federal Services/TRICARE

  Dec 2010 - now

  Delegation Compliance Auditor

   Manages the TRICARE network delegation audit process of individual groups located throughout the United States.  Develops corrective action plans, monitors progress, and follows up with delegated entity to ensure compliance.  Manages and monitors 75,000 networked individual and ancillary providers according to credentialing standards of all URAC NCQA state and federal regulations.  Coordinates and schedules audits using established URAC required tools based on contracting and regulatory requirements consistent with compliance standards.  Develops and maintains complete and accurate excel rosters for all assigned delegated groups and audits.  Communicates contractual compliance standards with providers, groups, and company peers.  Performs data entry in relation to compliance audits.  Carefully reviews medical record documentation and checks accuracy of documented findings.  Maintains records and reports in accordance with compliance standards.  Obtains information, resources, and training to perform audits and ensure regulatory compliance.  Analyzes discrepancies and trends in audit findings to make effective compliance decisions.  Updates policy and procedures as necessary.  Applies healthcare knowledge to solve a range of problems for internal and external stakeholders. Show less