Adrienne McPherson, MBA

Adrienne has proven healthcare experience, including leadership roles, in many aspects of compliance, administration, regulation oversight, and operations. Areas of expertise include Medicare compliance internal auditing; external audit coordination; CMS regulations; fraud, waste, and abuse detection and monitoring; First Tier, Downstream or Related Entity (FDR) oversight; and state health insurance regulations, particularly as they relate to Medicare Advantage plans and Medicaid managed care.

Experience

  • Experienced health plan Medicare compliance auditor with more than 30 CMS compliance and validation audits, including audits related to bid preparation for CMS Financial One-Third audits; developed auditing practices for Medicare Part C and D programs; and more than 20 financial and performance audits conducted as senior external audit coordinator
  • Created and managed plan and operations for internal and FDR auditing as Medicare compliance internal auditor
  • As director of provider relations, managed provider network and conducted onsite audits, recovering more than $800,000 in overpayment and third-party liability monies
  • Experience with private health insurance benefit plan administration and ACA guidelines, state exchange coordination, risk assessment development, coordination of cross-functional operational departments, and provider network administration and oversight.

Qualifications

  • Regulatory Expertise
  • Medicare and Medicaid Compliance
  • Risk Assessments and Internal Auditing

Education

  • Master of Business Administration, Pennsylvania State University
  • Bachelor of Arts, Business Administration, Whittier College

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