Open to opportunities

Lisbeth Cruz

@lisbethcruz

Message

I help healthcare teams ensure HIPAA and 340B compliance through claims audits and data validation.

Zimbabwe

Message

What I'm looking for

I’m seeking a Compliance Analyst or Claims Audit Analyst role where I can apply HIPAA and state/federal regulations, privacy incident analysis, audit monitoring, and compliance reporting—strengthening privacy controls, improving audit workflows, and delivering accurate, timely outcomes.

I’m a Healthcare Compliance and Claims Audit Analyst focused on translating federal and state requirements into clear, operational guidance. I combine HIPAA/privacy readiness with claims and eligibility auditing to reduce regulatory and program risk across complex health systems.

In my current work, I strengthen patient eligibility monthly by reviewing Epic medical records, encounter documentation, provider validation, and insurance plans—identifying 5–10% ineligible providers, locations, and encounters to lower exposure. I also mitigate 340B program liabilities through audits of Medicaid claims, modifiers, and dispensation activity, while maintaining optimized 340B split-billing operations using Sentry software and compliance monitoring across hospital and contract pharmacy settings.

Previously, I supported payer and benefit rule compliance at Pan-American Life Insurance Group by completing 100+ weekly audits, preparing documentation, and validating system configurations to ensure alignment with regulatory and contractual requirements. Across roles, I’ve collaborated with compliance, legal, pharmacy leadership, and external partners to improve data accuracy to 99.9%, strengthened secure data handling in line with HIPAA Privacy & Security, and used analytics and process improvement training (including Lean Six Sigma and Google Data Analytics) to make audit workflows faster and more reliable.

Experience

Work history, roles, and key accomplishments

340B Program Compliance Analyst

UNC Health

Feb 2022 - Apr 2026 (4 years 2 months)

Strengthened monthly patient eligibility auditing for hospital-based and contract pharmacy settings by reviewing Epic records and insurance plans, identifying 5–10% ineligible providers, locations, and encounters. Reduced 340B program risk and liabilities by auditing Medicaid claims and supporting accurate split-billing and regulatory reporting through 5+ monthly, 4+ quarterly, and 2+ annual audit

Claims Auditing HIPAA compliance HRSA & Regulatory Data Validation Regulatory Reporting

Claims Audit and Compliance Analyst

Pan-American Life Insurance Group

Sep 2017 - Feb 2022 (4 years 5 months)

Performed 100+ weekly claims audits across diverse claim types to ensure alignment with regulatory and contractual requirements. Validated provider and benefit rule configurations, resolved claim discrepancies with cross-functional partners, and improved data accuracy to 99.9% to support compliance monitoring and reporting.

Claims Analysis Audit Preparation Compliance Monitoring Data Validation Regulatory Compliance Documentation Cross Functional Collaboration

Inventory Pharmacy Technician

CVS Pharmacy

Apr 2012 - Jul 2016 (4 years 3 months)

Supported accurate medication dispensing by performing pharmaceutical calculations and partnering with pharmacists to follow state and federal regulatory requirements. Reduced financial loss through proactive inventory management and optimized purchasing practices while assisting with periodic audits and reviews.

Pharmacy Compliance Inventory Management Audit Support Stock Management Risk reduction

Automated Logistical Specialist

U.S. Army Reserve

May 2008 - Mar 2013 (4 years 10 months)

Executed logistical support operations including inventory management and equipment distribution, coordinating logistics for military operations that achieved a 20% reduction in response times. Managed logistical databases to track assets and trained junior personnel in logistical procedures and software applications.

Inventory Management Equipment Distribution Logistics Management Support Operations Supply Chain Coordination Training Process Improvement