Regina Nelson

Experience

• 

  Various Companies

  Jan 1994 - Jan 2006

  Previous Work History

  CONTRACT PARALEGAL 2004 – 2006State of Tennessee, TennCare Eligibility Reform of 2004, Nashville, TN ➤ Developed, coordinated, and implemented eDiscovery tools for federal class action cases. Reviewed disenrolled and medical necessity appeals and prepared cases for hearing. Coordinated eligibility and enrollment review with Department of Human Services and other applicable State agencies. Developed and implemented Medicaid-specific HIPAA Toolkit. PRIVATE PRACTICE – CIVIL & CRIMINAL LITIGATION PARALEGAL 1994 – 2004Nashville, Chattanooga, Cleveland, TN & Dalton, GA ➤ Applied extensive private paralegal practice for the following legal practitioners:Bass, Berry & Sims | Caterpillar Financial Services Corp. | Logan, Thompson et al | Kinney, Kemp et al | Shumacker & Thompson | Chancy, Kanavos & Love Show less

• 

  TennCare

  Jan 2006 - Jan 2013

  Associate General Counsel & Privacy Officer

  Set stage for creating, designing, implementing, and maintaining privacy and security compliance for a $7.2 billion federal/state program while collaborating with senior management, other state agencies, and program personnel. Integral team member in security-related oversight and other key processes that formed the overall risk management framework. Participated, evaluated, and collaborated statewide HIE and Clinical Health Record.➤ Ensured and maintained compliance and efficiencies of privacy and other materials reflecting current organization and legal practices by guiding the developing risk management policies and procedures that significantly identified gaps and addressed relevant industry requirements.➤ Fostered compliance for data privacy and security awareness by directing and delivering privacy training and new employee orientation to all on and offsite workforce members, including employees, medical and professional staff, contractors, alliances, business associates, and other appropriate third parties in compliance with federal law.➤ Managed periodic development of risk management system solutions and automation for contract management, data protection, and provider compliance in coordination with the State’s other compliance and operational assessment functions.➤ Developed and established business continuity plan and disaster recovery plan for privacy-related business functions in collaboration with applicable departments.➤ Served as subject matter expert and information privacy consultant to critical organizational decisions relative to operations, information systems, communications, audit and program for all trading partner, business associate agreements, and external government audit teams. Show less

• 

  State of Tennessee, Commerce & Insurance, Division of TennCare Oversight

  Jan 2013 - now

  Compliance Officer

  Drives tactical deployment of strategic and operational goals by envisioning the protection of the public health and integrity of the TennCare Program that exhilarated initiatives in overseeing and monitoring TennCare Managed Care Companies’ (MCCs) compliance in statutory and contractual requirements relating to financial responsibility, stability and integrity. Plans and organizes weekly MCC conference calls.➤ Key role in providing in medical, behavioral, transportation, and long-term care services and support providers by administering the provider complaint and independent review processes and maintaining case management of all material modifications which strategically reinforced dispute resolution process of MCCs.➤ Enhances due diligence processes and increases transparency culture by strictly reviewing operational documents for compliance, analyzing requirements for operational risks and denied claims, and generating comprehensive approvals and deficiencies while adhering to all applicable laws.➤ Devised and implemented the Division of TennCare Oversight Policies & Procedures ensuring highest possible level of compliance and controls across division.➤ Evaluates risk awareness and unblocks gaps in privacy and security compliance by creating and delivering annual Division HIPAA/HITECH Training programs to assess compliance risks, prioritize resources, and effectively address critical safeguard priorities of an organization. Show less