Kristen J. Brown
Compliance Director @Aetna, A Cvs Health Company
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WORK HISTORY
Compliance Director @Aetna, A Cvs Health Company
New Albany, OH, US
Aetna – New Albany, Ohio 2014 – Present Aetna Better Health of Ohio provides managed healthcare to members with both Medicare and Medicaid insurance coverage as a Medicare-Medicaid Plan (also known as the CMS Medicare/MMP Financial Alignment Initiative and the Ohio Department of Medicaid MyCare Ohio Program). Lead the implementation of effective Medicare and Medicaid Compliance Programs. Proactively advise business leaders and assess health plan risk to prevent, detect and correct regulatory compliance gaps. Implement program integrity. Promote compliance with corporate policies and an ethical culture. Responsible for coordinating responses to regulatory audits and inquiries; implementing compliance training; monitoring administrative agency activity; and, advising affected business leads and assisting in implementation of any required operational changes. Analyze legal and contractual requirements for organizational impact and implementation; help develop internal policies and procedures. Responsible for ensuring that the contractual and regulatory requirements are achieved by partnering with operations and medical case management business units. Primary interface with regulators on compliance matters. Conduct proactive reviews of compliance with high risk processes or issues. Initiate and monitor implementation of corrective action plans as necessary. Facilitate and deliver compliance education to promote awareness and understanding of compliance issues and consequences of noncompliance. Act as resource to staff on regulatory and compliance issues, as well as laws and regulations affecting Aetna’s Medicare-Medicaid business. Help prepare and lead health plan through external audits.Coordinate organizational response to audits and inquiries by regulatory agencies. Provide reports on compliance program activities, trends and issues to senior management.
EDUCATION
The Ohio State University
B.A., Political Science
Capital University Law School
J.D. cum laude
SKILLS
ABOUT KRISTEN J. BROWN
Accomplished attorney and compliance professional for regulated industries, including insurance and managed care companies, hospital systems and other healthcare providers, and government agencies. Legal and Business Acumen:Compliance, Government Relations and Policy Effective Compliance Program Implementation CMS, Medicaid, Medicare NAIC Model Law Development and Policy Analysis Legislative Drafting and Advocacy Liaison with Government Agencies and Regulatory Bodies Government and Internal Investigations HIPAA, Fraud, Waste & Abuse, Data Security/Breach and Document Retention Policies Author Chapter 98 of the New Appleman on Insurance Law Edition. Business and Administration: Policy and Procedure Development and Implementation Organizational Training Design and Implementation Contract Drafting and Negotiation Strategic Legal Counsel Initiatives Administration and Leadership Budgeting and Cost Containment Litigation and Litigation Management: Litigator, General and Complex Business Litigation Class Action Defense Managing Outside Counsel Relationships Case Assessment Plans Mediation Litigation Consulting
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