Consulting Manager with particular focus on managed Medicare product lines including Part C and Part D. Strong plan operations knowledge including Customer Service, Marketing, Enrollment, Sales and Grievance & Appeals. Compliance experience includes working with plans to review all plan aspects to ensure federal (and state where applicable) compliance while maintaining an effective business flow. Additional, experience includes performing compliance reviews, internal audits, site visit preparation and operational review. Proficiency in conducting staff training to prepare for audits and to ensure program compliance. Expertise working with clients on Corrective Action Plans. Experience in completing MA, PD and SNP applications working with new MA plan to ensure all documentation provided was thorough and compliant. Has prepared and reviewed workflows and Policies & Procedures to support compliance. Has conducted preparation of ANOC, EOC, Summary of Benefits, Provider Directory and Drug List text, plan letters with a keen ability to work each stage of the process from text development to proofing of final text and formats for design stage. Maintains hands on interaction with all levels of staff to coach, train and correct operational issues. Has supported clients including HMOs, MMPs, PPOs, Special Needs Plans (SNPs), Medicaid HMOs.
- Worked as a Managed Care Consultant providing consulting services to health plans with particular focus on Medicare Advantage (MAPD) Plans.
- Served as Part C and Part D subject matter expert for development of a compliance system.
- Provided support as Director, Program Development, for a managed care subsidiary of an East Coast Blues plan.
- Supported the development and implementation of a managed Medicare product.
- Managed Medicare product lines extensive knowledge
- Medicare Compliance
- BA in Career Writing with a Minor in Business Administration, Roger Williams University, Bristol, RI