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Regina Alexander

Director of IRO Services | FACHE, CHC, HCS-D, HCS-H

A Senior Manager on our Healthcare Compliance and Credentialing team, Regina is a healthcare compliance and revenue cycle operations expert. In her role as the Director of Independent Review Organization (IRO) Services, Regina supports clients under Corporate Integrity Agreements with the HHS OIG in meeting their specific compliance obligations associated with CIA terms, including claims and arrangements reviews.

Over her 25+ year career, Regina has served in many roles, including as Director of Health Information Management (HIM) and Privacy Officer for a community hospital, Associate Director of HIM for a large health system, and Senior Product Manager/Medicare Advantage for a regional health plan. Her experience on the payer side of the industry provides unique and practical compliance and revenue integrity insights for healthcare provider side clients.

A Senior Manager on our Healthcare Compliance and Credentialing team, Regina is a healthcare compliance and revenue cycle operations expert. In her role as the Director of Independent Review Organization (IRO) Services, Regina supports clients under Corporate Integrity Agreements with the HHS OIG in meeting their specific compliance obligations associated with CIA terms, including claims and arrangements reviews.

Over her 25+ year career, Regina has served in many roles, including as Director of Health Information Management (HIM) and Privacy Officer for a community hospital, Associate Director of HIM for a large health system, and Senior Product Manager/Medicare Advantage for a regional health plan. Her experience on the payer side of the industry provides unique and practical compliance and revenue integrity insights for healthcare provider side clients.

Regina’s credentials include Certification in Healthcare Compliance (CHC) through the Health Care Compliance Association. She holds current certifications as a Home Care Coding Specialist (HCS-H and HCS-D) through the Association of Home Care Coding and Compliance (AHCC). She is also a board-certified fellow (FACHE) in healthcare management through the American College of Healthcare Executives. 

Experience highlights 

  • Medicare and Medicaid payment and program policy 
  • Laboratory, inpatient facility, home health, and hospice coding and documentation reviews 
  • Payer audit response 
  • Compliance plan development and effectiveness reviews 
  • HIPAA Privacy and 21st Century Cures Act consulting 
  • Health Information Management (HIM) process improvement 
  • Revenue cycle operations management 
  • Stark and anti-kickback statutes compliance 
  • Focus arrangements tracking 
  • Corporate Integrity Agreement (CIA) monitoring 

Presentations

  • 2021 Home Health and Hospice Compliance Work Plans: Addressing New Risks and Fresh Takes on Old Favorites, Health Care Compliance Association (HCCA) Webinar, 2021
  • We Cannot Make This Stuff Up: Tales of Non-compliance and Risk Management, Health Care Compliance Association (HCCA) National Compliance Institute Presentation, 2020
  • Security Incident or Breach? The Differences, Making the Right Call, and Why it Matters, Medical Group Management Association (MGMA) Webinar, 2019
  • Behavioral Health and SUD Services: Getting paid is the easy part!, Healthcare Financial Management Association MA/RI Chapter Annual Compliance Update, 2019
  • Challenges of the Hybrid Medical Record: Impact on Clinical, Coding, and Fiscal Outcomes, Lorman Educational Services Webinar, 2019
  • PDGM and PDPM: Potential Compliance Perils of Post-Acute Payment Model Change, Health Care Compliance Association (HCCA) Webinar, 2019
  • Start with the End in Mind: Investigating Workforce Violations of the HIPAA Privacy Rule, Health Care Compliance Association (HCCA) Webinar, 2019
  • Unknown Unknowns: How what you don’t know about provider credentialing, privileging and enrollment creates strategic and compliance risks, barriers to care, and claim denials,  New England Society for Healthcare Strategy (NESHS), 2018
  • Far Beyond Hospital Walls: Making the Case for HIM and CDI Professionals in the Post-Acute World, Connecticut Health Information Management Association (CTHIMA), 2018
  • The Unknown Unknowns of Credentialing, Privileging and Enrollment, Health Care Compliance Association (HCCA) Webinar, 2018
  • 42 CFR Part 2 and HIPAA: Intersection or Roundabout?, Connecticut Hospital Association (CHA) Issue Based Forum, 2018
  • 42 CFR Part 2,  Connecticut Medical Group Management Association (CMGMA), 2017

Memberships and committees 

Insights

EDUCATION

BS, Health Administration - Long Term Care, University of Phoenix 

MBA, The George Washington University 

CERTIFICATIONS

  • FACHE
  • CHC
  • HCS-D
  • HCS-H