Anthony Edwards

About Anthony Edwards

Accomplished Compliance Officer with more than a decade of experience developing and managing effective corporate compliance programs and personnel surrounding multiple jurisdictions inclusive of Medicare, Medicaid, CHIP, state, QHP (FFM), and Federal Acquisition Regulation resulting in collaborative, actionable, and informed business decisions. Conceptual thinker and problem solver. Adept at establishing and fostering relationships with stakeholders to mitigate or resolve substantiated and evolving concerns.

Experience

1. Associate Director of Compliance

   UnitedHealth Group

   Jan 2017 — Present

   Facilitate the ongoing development and manage a Team supporting regulatory compliance for multiple jurisdictions. • Compliance Officer for several Medicaid Managed Care Plans and prime contracts supporting Medicaid Agencies. • Thoughtful consideration and response to complex and evolving statutory, regulatory, contractual, and procurement requirements supporting actionable and informed business decisions and strategy. • Successful CMS and State Audits through the development of training, audit readiness tools, training, and interview preparation of Operational Leads in collaboration with compliance colleagues, and other enterprise departments such as legal, privacy, and security. • Through collaborative dialogue with internal business owners, Clients, and Regulatory Agencies address or mitigate escalated regulatory concerns. • Developed, initiated or overseen corrective action plans to support Business Owners in correcting substantiated material compliance concerns. • Enterprise recognized Subject Matter Expert for Optum Corporate Compliance for Medicare, Medicaid, and Health Insurance Marketplaces leveraging my knowledge to support informed Leadership decisions, colleagues understanding and response to identified issues of non-compliance, regulatory complaints, audits, and corrective action plans.• Collaboration with Legal, and Business Owners to identify and describe how the organization will avoid or mitigate perceived, potential, or actual Organizational Conflicts of Interest.

Education

• Arizona State University

  BS, Exercise Science and Wellness

  1996 — 2000

• Keller Graduate

  Masters, Finance and Accounting

  2007 — 2010

Skills

• Analysis
• Medicaid
• Leadership
• Process Improvement
• Pharmacy Benefit Management
• Disease Management
• Utilization Management
• Performance Improvement
• Business Analysis
• Revenue Cycle Management
• Healthcare Information Technology
• Credentialing
• Visio
• Business Process Improvement
• Medicaid Managed Care
• Behavioral Health
• Medical Compliance
• U.s. Health Insurance Portability and Accountability Act (Hipaa)
• Healthcare Management
• Accounting
• Vendor Management
• Team Building
• Management
• Data Analysis
• Cross-Functional Team Leadership
• Revenue Cycle
• Quality Improvement
• Hipaa
• Policy
• Auditing
• Informatics
• Medicare
• Healthcare
• Strategic Planning
• Training
• Health Insurance
• Managed Care
• Health Policy
• Insurance
• Internal Audit