Brigitte Doleshal

Experience

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  KPMG

  Jan 1991 - Jan 1994

  Supervising Senior - Audit

  Planned and managed audits of health care, property and casualty, and life insurance clients. Led engagement teams to perform test work in third party reimbursement, accounts receivable, and Medicare cost reporting.

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  HealthNet

  Jan 1994 - Jan 2001

  Financial Reporting Manager / Underwriter / Senior Financial Accountant / Supervisor

  Coordinated, analyzed, and reported results of the annual corporate budget. Implemented accounts payable and payroll policies and procedures. Managed risk sharing arrangements between network physicians and health plans. Calculated and analyzed underwriting risk for client employers. Created provider fee schedules and reimbursement models, including capitation and withhold payment plans.

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  Sprint Nextel

  Jan 2001 - Jan 2002

  Senior Financial Analyst

  Coordinated and consolidated monthly P&L forecast and budget for cell, long distance, and local phone services.

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  Cerner Corporation

  Jan 2002 - Jan 2004

  Enterprise Controller

  Managed and executed financial planning, forecasting, and reporting for revenue cycle product lines with $30 million in annual expenses. Monitored and managed expenses including staffing and salary costs.

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  Ifft & Co. PA

  Jan 2005 - Jan 2006

  Senior Auditor
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  CHAN Healthcare Auditors

  Feb 2006 - Jun 2015

  Audit Director

  • Identification and evaluation of compliance, financial, and operational risks. Included implementation of a comprehensive risk assessment and audit process to prioritize risks with highest impact on business objectives. Served client affiliate health systems in Des Moines, IA, Little Rock, AR, Reading, PA, Lufkin, TX, and Houston, TX. • Provided consultation and audits of physician contract compliance. Developed comprehensive expertise in regulatory requirements for contracts with providers. Identified significant savings related to overpayments, prevention of Stark violations, and identification of misrepresentation of revenues, saving the organization thousands.• Designed training programs and audit tools for audits of Affirmative Action and Medicare Shared Savings Programs / ACOs. Audit Senior Manager & Audit Manager, Kansas City, MOResponsible for the annual audit plan for four health systems in Kansas City, MO, Waco, TX, Lewiston, ID, and Pasco, WA. Show less

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  UnityPoint Health

  Jun 2015 - Oct 2017

  Executive Director of Internal Audit

  • Led the audit team in addressing compliance, clinical, coding, financial, insurance, and operational risks based on a comprehensive risk assessment. • Served as Internal Audit’s representative on UnityPoint’s Enterprise Risk Management (ERM) Committee.• Made recommendations for process and internal control improvements. • Managed and responded to concerns reported to the Compliance Helpline. • Designed Unity Point Health’s first formal internal audit (IA) risk assessment process. Redesigned IA department policies, procedures, report templates and work paper tools to follow Institute of Internal Auditor (IIA) standards, improve consistency and promote a risk-based audit approach. Show less

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  SSM Health

  Mar 2018 - Jul 2022

  Senior Director - Compliance, ACO Compliance Officer

  • Responsible for strategic direction and day-to day operations of the compliance program. • Led efforts to mitigate fraud, waste, and abuse risks, and maintained compliance with Medicare, Medicaid, federal and state regulations.• Redesigned risk assessment, audit, and monitoring functions to more effectively address high risk compliance issues. Improvements led to real time mitigation of compliance risks, billing/coding outliers and paved the way for SSM’s Enterprise Risk Management (ERM) program.• Lead investigations into alleged violations of law and policies. Developed standardized tools and interview techniques for conducting investigations, interviewing perpetrators and witnesses. o Investigations led to thousands of dollars saved from P-Card fraud and prevention of inappropriate use of provider Drug Enforcement Agency (DEA) numbers.• Provided subject matter expertise to leaders responding to compliance and regulatory concerns. Analyzed allegations of Anti-Kickback, Stark, IRS, HIPAA and other violations of the law. • Produced solutions for compliantly addressing human subjects research questions, code of conduct violations and conflicts of interest.• Developed compliance policies, procedures, and training to address frequently identified risks. Created customized training to educate leaders on ACO/Medicare shared savings compliance, beneficiary inducement, vendor/third party relationship risks, fraud, waste, and abuse, conflicts of interest. Show less

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  Protiviti

  Oct 2022 - Jan 2023

  Internal Audit and Compliance

  • Led audit and compliance teams to perform risk mitigation projects for clients.

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  Acclara, an R1 Company

  Jan 2023 - now

  Corporate Compliance Officer, Senior Director

  • Designed and implemented Acclara’s compliance and privacy program from the ground up, establishing standards for effective day-to day operations of a compliance program based on the OIG's Seven Elements.• Identified and corrected compliance gaps, creating revenue cycle compliance policies, procedures, and standards as established by HIPAA, CMS, Fraud, Waste, and Abuse (FWA) and state regulations governing revenue cycle operations.• Lead compliance and privacy investigations in collaboration with operations and human resources.• Created FWA, privacy, and general compliance education, facilitating compliance with OIG regulations.• Created and led Acclara’s Governance, Risk and Compliance Committee, creating structure for oversight and guidance to the Compliance and IT Security programs.• Implemented the Compliance and Ethics Helpline, improving the process for reporting compliance issues and establishing an anonymous reporting tool.• Proactively identified risk with the establishment of a formal risk assessment process, leading to a comprehensive compliance and auditing work plan.• Advise and report to Senior leadership regarding compliance issues and incidents. Show less