Anthony Carter
Director, Customer & Member Services Compliance at Kaiser Permanente
Greater San Diego Area
Hospital & Health Care
Previous
BACTES Imaging Solutions, Group Health Cooperative, Washington State University
Education
Washington State University
242 connections
https://www.linkedin.com/in/anthony-carter-393a9767
Background
Senior Compliance Executive
Respected Compliance Leader with more than 12 year career leading successful health
care compliance programs within the health insurance industry. Extensive experience in
directing corporate and health plan operations compliance programs through
development and in accordance with Office of Inspector General (OIG) guidelines
including: implementation, planning, risk assessment, internal reporting, and risk-
mitigation/issue resolution. Skilled in the interpretation and cross-functional
implementation of state and federal regulations. Core Competencies include:
• Understanding of enterprise compliance program growth and development
• Corporate/Operations Compliance, Public Policy, and Regulatory Affairs
• Compliance Risk Management and best practices
• External audit management
• Interpretation of written guidelines and legal documents
• Ability to effectively communicate with senior management
• Excellent problem solving, analytical ability, oral and written communication skills
• Medicare/Medicaid Compliance Program management and implementation
Experience
Director, Customer & Member Services Compliance
Kaiser Permanente
August 2014 – Present (2 years)Greater San Diego Area
Responsible for leading compliance initiatives both within the compliance function as well
as across functions across the enterprise, as well as managing relationships and
maintaining communications with stakeholders at all levels, both internally and externally.
Accountable for brokering agreements and gaining support for compliance initiatives from
decision makers at all levels. Leads and directs the researching, planning,
implementation, and monitoring, validation, and reporting for a broad portfolio of
compliance systems and initiatives to enable organizational compliance with all applicable
Federal, state, and local regulations/laws, as well as overseeing the protection of
organizational assets. On an on-going basis, oversees the researching and interpretation
of regulations and laws to establish compliance standards, and may direct the
development and/or delivery of training and communications/change management
relative to new standards. Is responsible for the Assessment of organizational systems
(both physical and process or data related) to determine gaps in compliance and
determine opportunities for remediation. Advises the organization on all compliance
matters. May direct the investigation of violations of compliance policy, laws, regulations,
etc. or on-going monitoring and reporting to ensure remediation.
Privacy Officer
BACTES Imaging Solutions
March 2014 – August 2014 (6 months)Greater San Diego Area
• Ensure that all BACTES policies and procedures regarding Release of Information
(ROI), are being accurately maintained and organized, and call for changes when they
need to be made. When changes are required, ensure that the appropriate changes are
made and are made in a timely fashion.
• Conduct audits of security and privacy systems to ensure that we remain in compliance
with all governing laws and regulations including, but not limited to, federal and state
regulations, HIPAA and HITECH as they pertain to our role as a Business Associate of
multiple Covered Entities.
• Act as a resource to answer compliance questions/issues from BACTES field staff
• Oversee investigation, documentation and reporting of all potential privacy breaches.
• Oversee all required training for BACTES personnel including annual HIPAA training,
biannual CRIS certification, new policy and procedure training regarding privacy and
security
• Active participation in local SDHIA and/or other similar organizations
• Conduct seminars for clients and potential clients regarding topics such as HIPAA,
HITECH, Meaningful Use, internal auditing, etc.
• Oversee any BACTES-wide audit and compliance programs
• Participate in BACTES project teams as needed
• Contribute to pre-sales meetings with prospective clients
Health Plan Division Manager Compliance Programs
Group Health Cooperative
May 2009 – June 2013 (4 years 2 months)Greater Seattle Area
-Facilitate the development and implementation of the compliance planning process:
define and strategically prioritize risk, facilitate monitoring and auditing, and remediation
planning.
-Develop, organize and implement policies and procedures, guidelines and
communication necessary to support the compliance program. Design and manage to a
checking system that evaluates if compliance processes are standardized and in control,
manage contingency planning as needed.
-Interface with compliance areas including: Office of Compliance and Ethics, Corporate
Legal and divisional compliance areas. Require all staff to integrate applicable laws,
regulations, and contractual obligations as part of their daily standard work to ensure that
process results meet these obligations.
-Act as the single point of contact for the Health Plan Division compliance function.
Maintain conceptual and working knowledge of the health care industry regulatory
environment and its impact on health plan management.
-Provide compliance consultation and education to health plan staff. Use checking
systems to inform compliance education and training process requirements.
Manager, Compliance Programs
Group Health Cooperative
July 2001 – April 2009 (7 years 10 months)Greater Seattle Area
-Manage Provider Relations compliance program through identification of regulatory,
legal, accreditation and business requirements;
-Assess impact on network business functions; formulation of appropriate compliance
response: programs, policies and strategies; management of implementation strategies;
and compliance oversight, feedback and corrective action plans to professional
management and staff.
-External audit review oversight and coordination;
-Perform high level analysis of regulatory and statutory requirements and develops
policies to support legislative and regulatory provisions of Group Health provider
contracts.
Graduate Research Associate
Washington State University
August 1999 – May 2000 (10 months)Spokane, Washington Area
Graduate Research Associate
Financial analysis of profitability and solvency of HMOs;
Financial analysis of current Medicare/Medicaid beneficiaries by state;
Data collection/analysis of 10-Ks & 10-Qs and other SEC filings of publicly traded
companies.
Certifications
Health Care Compliance
Health Care Compliance Association, License Member Id: 105032
Starting October 2011
Director, Customer & Member Services Compliance at Kaiser Permanente
Greater San Diego Area
Hospital & Health Care
Previous
BACTES Imaging Solutions, Group Health Cooperative, Washington State University
Education
Washington State University
242 connections
https://www.linkedin.com/in/anthony-carter-393a9767
Background
Senior Compliance Executive
Respected Compliance Leader with more than 12 year career leading successful health
care compliance programs within the health insurance industry. Extensive experience in
directing corporate and health plan operations compliance programs through
development and in accordance with Office of Inspector General (OIG) guidelines
including: implementation, planning, risk assessment, internal reporting, and risk-
mitigation/issue resolution. Skilled in the interpretation and cross-functional
implementation of state and federal regulations. Core Competencies include:
• Understanding of enterprise compliance program growth and development
• Corporate/Operations Compliance, Public Policy, and Regulatory Affairs
• Compliance Risk Management and best practices
• External audit management
• Interpretation of written guidelines and legal documents
• Ability to effectively communicate with senior management
• Excellent problem solving, analytical ability, oral and written communication skills
• Medicare/Medicaid Compliance Program management and implementation
Experience
Director, Customer & Member Services Compliance
Kaiser Permanente
August 2014 – Present (2 years)Greater San Diego Area
Responsible for leading compliance initiatives both within the compliance function as well
as across functions across the enterprise, as well as managing relationships and
maintaining communications with stakeholders at all levels, both internally and externally.
Accountable for brokering agreements and gaining support for compliance initiatives from
decision makers at all levels. Leads and directs the researching, planning,
implementation, and monitoring, validation, and reporting for a broad portfolio of
compliance systems and initiatives to enable organizational compliance with all applicable
Federal, state, and local regulations/laws, as well as overseeing the protection of
organizational assets. On an on-going basis, oversees the researching and interpretation
of regulations and laws to establish compliance standards, and may direct the
development and/or delivery of training and communications/change management
relative to new standards. Is responsible for the Assessment of organizational systems
(both physical and process or data related) to determine gaps in compliance and
determine opportunities for remediation. Advises the organization on all compliance
matters. May direct the investigation of violations of compliance policy, laws, regulations,
etc. or on-going monitoring and reporting to ensure remediation.
Privacy Officer
BACTES Imaging Solutions
March 2014 – August 2014 (6 months)Greater San Diego Area
• Ensure that all BACTES policies and procedures regarding Release of Information
(ROI), are being accurately maintained and organized, and call for changes when they
need to be made. When changes are required, ensure that the appropriate changes are
made and are made in a timely fashion.
• Conduct audits of security and privacy systems to ensure that we remain in compliance
with all governing laws and regulations including, but not limited to, federal and state
regulations, HIPAA and HITECH as they pertain to our role as a Business Associate of
multiple Covered Entities.
• Act as a resource to answer compliance questions/issues from BACTES field staff
• Oversee investigation, documentation and reporting of all potential privacy breaches.
• Oversee all required training for BACTES personnel including annual HIPAA training,
biannual CRIS certification, new policy and procedure training regarding privacy and
security
• Active participation in local SDHIA and/or other similar organizations
• Conduct seminars for clients and potential clients regarding topics such as HIPAA,
HITECH, Meaningful Use, internal auditing, etc.
• Oversee any BACTES-wide audit and compliance programs
• Participate in BACTES project teams as needed
• Contribute to pre-sales meetings with prospective clients
Health Plan Division Manager Compliance Programs
Group Health Cooperative
May 2009 – June 2013 (4 years 2 months)Greater Seattle Area
-Facilitate the development and implementation of the compliance planning process:
define and strategically prioritize risk, facilitate monitoring and auditing, and remediation
planning.
-Develop, organize and implement policies and procedures, guidelines and
communication necessary to support the compliance program. Design and manage to a
checking system that evaluates if compliance processes are standardized and in control,
manage contingency planning as needed.
-Interface with compliance areas including: Office of Compliance and Ethics, Corporate
Legal and divisional compliance areas. Require all staff to integrate applicable laws,
regulations, and contractual obligations as part of their daily standard work to ensure that
process results meet these obligations.
-Act as the single point of contact for the Health Plan Division compliance function.
Maintain conceptual and working knowledge of the health care industry regulatory
environment and its impact on health plan management.
-Provide compliance consultation and education to health plan staff. Use checking
systems to inform compliance education and training process requirements.
Manager, Compliance Programs
Group Health Cooperative
July 2001 – April 2009 (7 years 10 months)Greater Seattle Area
-Manage Provider Relations compliance program through identification of regulatory,
legal, accreditation and business requirements;
-Assess impact on network business functions; formulation of appropriate compliance
response: programs, policies and strategies; management of implementation strategies;
and compliance oversight, feedback and corrective action plans to professional
management and staff.
-External audit review oversight and coordination;
-Perform high level analysis of regulatory and statutory requirements and develops
policies to support legislative and regulatory provisions of Group Health provider
contracts.
Graduate Research Associate
Washington State University
August 1999 – May 2000 (10 months)Spokane, Washington Area
Graduate Research Associate
Financial analysis of profitability and solvency of HMOs;
Financial analysis of current Medicare/Medicaid beneficiaries by state;
Data collection/analysis of 10-Ks & 10-Qs and other SEC filings of publicly traded
companies.
Certifications
Health Care Compliance
Health Care Compliance Association, License Member Id: 105032
Starting October 2011
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