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#22-005484-0020
Supplemental Questionnaire

Last Name
First Name

 

***Please note that your answers on the supplemental questionnaire must correspond to the information provided on your application to receive credit. Applications that do not include a completed supplemental questionnaire will be considered incomplete and may be subject to disapproval.***


1.

Please describe your experience developing and managing compliance programs including federal and state requirements compliance. Include employer names, dates of employment, and relevant job duties in your response. If you do not have this experience, enter N/A.

2.

Please describe your experience in a related role with experience providing consultation to executive management and demonstrated experience formulating strategy, driving change, and influencing decisions. Include employer names, dates of employment, and relevant job duties in your response. If you do not have this experience, enter N/A.

3.

Please describe your experience leading cross functional teams to develop and deliver enterprise-wide programs, initiatives, or projects. Include employer names, dates of employment, and relevant job duties in your response. If you do not have this experience, enter N/A.

4.

Please describe your working knowledge of the ACA. Include employer names, dates of employment, and relevant job duties in your response. If you do not have this experience, enter N/A.

5.

Please describe your working experience with HIPAA privacy compliance. Include employer names, dates of employment, and relevant job duties in your response. If you do not have this experience, enter N/A.

6.

Please list your professional certifications. If you do not have any, please type N/A.


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