Amy K, MBA, LPN
NCQA Accreditation & Healthcare Compliance Consultant
Accreditation Readiness | Mock Audits | Regulatory Gap Analysis | Policy & Program Development
Healthcare compliance and accreditation consultant with extensive experience supporting NCQA accreditation readiness, regulatory compliance, and quality program development across Medicaid and managed care organizations. Skilled at translating complex NCQA, CMS, and regulatory requirements into clear policies, operational workflows, and audit‑ready documentation that strengthen organizational performance. Experienced in conducting mock audits, identifying compliance gaps, and guiding cross‑functional teams through accreditation preparation and remediation initiatives. Known for delivering practical, implementation‑focused solutions that help organizations achieve and sustain NCQA accreditation standards while improving operational efficiency and regulatory readiness.
Consulting Engagement Focus
• NCQA accreditation readiness and documentation review
• Mock audits and regulatory gap assessments
• Policy and procedure framework development
• Quality program infrastructure and governance support
• Operational process alignment with NCQA and CMS requirements
Core Consulting Capabilities
• NCQA Accreditation Readiness
• Regulatory Compliance (NCQA, CMS, Medicaid)
• Policy & Procedure Development
• Mock Audits & Documentation Review
• Quality Improvement Programs
• Operational Process Design
• Regulatory Gap Analysis
• Cross‑Functional Stakeholder Collaboration
• Healthcare Compliance Training
• Audit Preparation & Remediation
Professional Experience
INTEGRA PARTNERS (Remote)
Medical Policy & Compliance Specialist | 2025 – Present
• Support regulatory compliance initiatives ensuring alignment with FDA, ISO 13485, and EU MDR regulatory frameworks.
• Develop, review, and implement medical policies, SOPs, and compliance documentation translating regulatory requirements into operational procedures.
• Conduct internal compliance reviews and audits identifying regulatory gaps and supporting corrective action planning.
• Collaborate with clinical, regulatory, and operational stakeholders to ensure consistent interpretation and implementation of regulatory requirements.
• Support implementation of regulatory governance frameworks strengthening organizational audit readiness.
• Provide regulatory education and training to internal teams improving compliance awareness and documentation practices.
CAPITAL BLUE CROSS (Remote)
Senior Quality & Accreditation Consultant | 2023 – 2025
• Led NCQA accreditation readiness initiatives across business units supporting Medicaid regulatory compliance.
• Conducted accreditation gap assessments and supported quality improvement strategies aligned with NCQA standards.
• Facilitated collaboration between quality, compliance, and operational teams strengthening regulatory readiness.
• Redesigned NCQA documentation improving usability, compliance tracking, and cross‑department engagement.
• Supported development of governance processes strengthening quality program infrastructure.
CENTENE – PEACH STATE HEALTH PLAN (Remote)
Accreditation Specialist | 2022 – 2023
• Managed NCQA accreditation documentation and survey readiness activities for Medicaid product lines.
• Conducted mock audits and documentation reviews ensuring compliance with NCQA accreditation standards.
• Streamlined the medical policy review process aligning documentation with NCQA and state Medicaid requirements.
• Applied PDSA and root cause analysis methodologies to improve regulatory compliance workflows.
• Achieved 100% compliance in chart audit documentation during NCQA survey preparation.
ASHFIELD ENGAGE (Remote)
Quality Compliance Analyst | 2021 – 2022
• Supported compliance monitoring within an FDA REMS program.
• Delivered regulatory education to providers and internal teams supporting program compliance.
• Investigated non‑compliance events and implemented corrective action plans improving documentation accuracy and operational workflows.
SELMAN‑HOLMAN, LLC (Remote Contract)
Pre‑Claim Review Specialist | 2020 – 2021
• Reviewed clinical documentation ensuring compliance with federal regulatory requirements.
• Supported fraud prevention and strengthened revenue cycle integrity through detailed documentation review.
HIGHMARK HEALTH (Remote)
Senior Clinical Quality Management Analyst | 2019 – 2020
Clinical Quality Management Analyst | 2017 – 2019
• Led provider audit and quality improvement initiatives supporting HEDIS performance and documentation accuracy.
• Directed quality assurance efforts across a 7‑county provider network conducting audits and trend analysis.
• Achieved ≥95% accuracy in risk adjustment coding review.
• Educated providers on HEDIS measures, coding, and documentation standards improving compliance and patient outcomes.
• Implemented remote EMR access improving chart audit efficiency and productivity.
Education | Licensure | Professional Development
• Master of Business Administration (MBA), Healthcare Administration – Southern New Hampshire University
• Bachelor of Arts (BA), Psychology – Southern New Hampshire University
• Licensed Practical Nurse (LPN) – Hazleton Area Career Center
• Lean Six Sigma Green Belt – In Progress
• Lean Six Sigma Yellow Belt – Completed
• AAPC Certified Risk Adjustment Coder (Non‑Active)
