Experience

Devoted Health

• United States
• Hospitals and Health Care
• 700 & Above Employee

• Director

  • Dec 2022 - Present

• Director of Sales Compliance

  • Dec 2022 - Present



Benefytt Technologies

• United States
• Insurance
• 1 - 100 Employee

• Chief Medicare Compliance Officer

  • Sep 2020 - Dec 2022



Integritas Medicare Consulting

• Senior Vice President

  • Jan 2021 - May 2021



Medicare Compliance Solutions

• Vice President

  • Mar 2020 - Dec 2020



Aetna, a CVS Health Company

• United States
• Wellness and Fitness Services
• 700 & Above Employee

• Senior Director -- Medicare Compliance

  • Jan 2011 - Dec 2019

  • Directed team within Medicare compliance overseeing following MA and Part D areas: Enrollment, Billing, Employer Groups, Medical and Pharmacy Network, Sales and Marketing, and new plan products. • Provided regulatory and compliance direction for these areas, including review, interpretation and assistance in the implementation of new CMS requirements. • Coordinated and implemented risk assessment strategy for these areas, using results to develop and implement annual audit work plan.… Show more • Directed team within Medicare compliance overseeing following MA and Part D areas: Enrollment, Billing, Employer Groups, Medical and Pharmacy Network, Sales and Marketing, and new plan products. • Provided regulatory and compliance direction for these areas, including review, interpretation and assistance in the implementation of new CMS requirements. • Coordinated and implemented risk assessment strategy for these areas, using results to develop and implement annual audit work plan. • Proactively identified areas of compliance risks, when possible, and escalated critical issues to senior leadership. • Assisted business in the development of strategies to address compliance barriers and tracked corrective actions to remediate compliance issues. • Key contributor to CMS audits, compiling necessary universe and sample data; developed compliance program effectiveness case selections (i.e. CPE “tracers) and presented to auditors. Provided technical consultation and compliance support for various business audits (e.g. CMS financial audits). • Reported regularly to senior leadership, executive committees and Federal regulators on policy issues and compliance activity within the organization. Show less • Directed team within Medicare compliance overseeing following MA and Part D areas: Enrollment, Billing, Employer Groups, Medical and Pharmacy Network, Sales and Marketing, and new plan products. • Provided regulatory and compliance direction for these areas, including review, interpretation and assistance in the implementation of new CMS requirements. • Coordinated and implemented risk assessment strategy for these areas, using results to develop and implement annual audit work plan.… Show more • Directed team within Medicare compliance overseeing following MA and Part D areas: Enrollment, Billing, Employer Groups, Medical and Pharmacy Network, Sales and Marketing, and new plan products. • Provided regulatory and compliance direction for these areas, including review, interpretation and assistance in the implementation of new CMS requirements. • Coordinated and implemented risk assessment strategy for these areas, using results to develop and implement annual audit work plan. • Proactively identified areas of compliance risks, when possible, and escalated critical issues to senior leadership. • Assisted business in the development of strategies to address compliance barriers and tracked corrective actions to remediate compliance issues. • Key contributor to CMS audits, compiling necessary universe and sample data; developed compliance program effectiveness case selections (i.e. CPE “tracers) and presented to auditors. Provided technical consultation and compliance support for various business audits (e.g. CMS financial audits). • Reported regularly to senior leadership, executive committees and Federal regulators on policy issues and compliance activity within the organization. Show less



Centers for Medicare & Medicaid Services

• United States
• Government Administration
• 700 & Above Employee

• Technical Advisor, Senior Policy Analyst

  • Aug 2010 - Dec 2010

  Note - Senior Policy Analyst in Division with similar functions from May 1998 - July 2008 • Technical advisor and team lead for Division of Enrollment and Eligibility Policy. • Developed, evaluated, and issued national program policy for Medicare health and prescription drug plans. • Provided guidance to Medicare plans, CMS central and regional office staff, SSA and other relevant parties. • Regulation writer for several key Medicare health and drug plan legislation, including:… Show more Note - Senior Policy Analyst in Division with similar functions from May 1998 - July 2008 • Technical advisor and team lead for Division of Enrollment and Eligibility Policy. • Developed, evaluated, and issued national program policy for Medicare health and prescription drug plans. • Provided guidance to Medicare plans, CMS central and regional office staff, SSA and other relevant parties. • Regulation writer for several key Medicare health and drug plan legislation, including: The Balanced Budget Act of 1997; the Medicare Prescription Drug, Improvement, and Modernization Act of 2003; and the Patient Protection and Affordable Care Act. • Briefed senior CMS and department leadership on critical enrollment policy issues. Provide technical enrollment policy consultation and participate in the development of key agency initiatives. • Led national training for internal and external stakeholders on Medicare enrollment policy. • Developed beneficiary materials related to Medicare enrollment. Advised CMS publications’ staff on national beneficiary communication materials (e.g. Medicare handbook and Medicare.gov). • Advised U.S. Congressional staff during statutory development process and on various Medicare enrollment policy issues. • Served as national Medicare enrollment policy expert at industry and advocacy conferences and liaison with various industry trade associations, advocacy groups, and other key external partners.

• Director, Division of Enrollment & Eligibility Policy (Medicare Enrollment and Appeals Group)

  • Jul 2008 - Aug 2010

  • Supervised team responsible for Medicare managed care, prescription drug, & fee-for-service programs eligibility & enrollment program. • Analyzed Medicare legislation, determining and developing needed regulation and guidance. Monitored and evaluated implementation efforts of such policies. • Briefed senior leadership, CMS regional offices, SSA and other CMS components on critical enrollment policy issues. • Trained Medicare health and prescription drug plans, and other… Show more • Supervised team responsible for Medicare managed care, prescription drug, & fee-for-service programs eligibility & enrollment program. • Analyzed Medicare legislation, determining and developing needed regulation and guidance. Monitored and evaluated implementation efforts of such policies. • Briefed senior leadership, CMS regional offices, SSA and other CMS components on critical enrollment policy issues. • Trained Medicare health and prescription drug plans, and other internal/external entities on eligibility, enrollment, entitlement and related issues. • Coordinated with CMS publication staff on national beneficiary communication materials. • Advised Congressional staff on a variety of Medicare enrollment policy issues and provided technical assistance during statutory development process.



Centers for Medicare & Medicaid Services

• United States
• Government Administration
• 700 & Above Employee

• Health Policy Analyst

  • Jun 1997 - May 1998

  • Policy analyst within the Federal Medicaid Disabled and Elderly Health Programs’ Group. • Project Officer for Medicaid waiver and demonstration programs for beneficiaries with special needs with the Center for Medicaid and State Operations’ Disabled and Elderly Health Programs Group. • Managed all aspects of the waiver/demonstration project from the concept phase through implementation of the program, as well as post-implementation monitoring and evaluation activities. • Primary… Show more • Policy analyst within the Federal Medicaid Disabled and Elderly Health Programs’ Group. • Project Officer for Medicaid waiver and demonstration programs for beneficiaries with special needs with the Center for Medicaid and State Operations’ Disabled and Elderly Health Programs Group. • Managed all aspects of the waiver/demonstration project from the concept phase through implementation of the program, as well as post-implementation monitoring and evaluation activities. • Primary liaison between the State, CMS regional offices, OMB, DHHS, and other stakeholders. Briefed senior management on significant issues. • Determined cost effectiveness of a waiver or demonstration project. Evaluated cost models provided by the States and their contractors. Obtained financial data from CMS systems and developed additional cost models and budget-related documents to verify States’ financial assumptions. Analyzed financial data and trends to project future costs.

• Health Policy Analyst

  • Jun 1995 - Jun 1997

  • Policy analyst within CMS’ Office of Long-Term Care Services, Center for Medicaid and State Operations. • Reviewed, evaluated, and developed Medicaid coverage and payment for the elderly and people with disabilities; primary subject areas included coverage of intermediate care facilities for the mentally retarded (ICFs/MR) and nursing facilities. • Reviewed and evaluated State Plan Amendments (SPAs) relating to payment for services provided in nursing facilities and intermediate care… Show more • Policy analyst within CMS’ Office of Long-Term Care Services, Center for Medicaid and State Operations. • Reviewed, evaluated, and developed Medicaid coverage and payment for the elderly and people with disabilities; primary subject areas included coverage of intermediate care facilities for the mentally retarded (ICFs/MR) and nursing facilities. • Reviewed and evaluated State Plan Amendments (SPAs) relating to payment for services provided in nursing facilities and intermediate care facilities. • Developed ICFs/MR and nursing facility coverage policy. • Provided technical assistance to regional offices, States, and providers on various policy issues, including conditions of participation for ICFs/MR and nursing facility services. Issued and clarified policies through memoranda, letters, and regulations.

• Presidential Management Fellow

  • Jun 1993 - Jul 1995

  Completed five rotational assignments as part of the program: • CMS Office of Survey and Certification. Prepared analyses of survey process and reviewed state surveyor staffing levels and resource needs for the Clinical Laboratory Improvement Amendments (CLIA) program. Created new survey activity and cost analysis reports. Formulated bi-monthly state budget allocations and assisted in preparation of annual budget directives. • United States Senate, Labor & Human Resources… Show more Completed five rotational assignments as part of the program: • CMS Office of Survey and Certification. Prepared analyses of survey process and reviewed state surveyor staffing levels and resource needs for the Clinical Laboratory Improvement Amendments (CLIA) program. Created new survey activity and cost analysis reports. Formulated bi-monthly state budget allocations and assisted in preparation of annual budget directives. • United States Senate, Labor & Human Resources Committee, Subcommittee on Aging. Staffed committee on national health care reform initiative and other health care Issues. Performed legislative analysis and briefed national organizations and industry representatives on provisions. Staff subcommittee meetings and developed speeches, briefs and talking points for subcommittee Chairperson. • CMS Office of Medicare Benefits, Part B Medicare Review. Reviewed durable medical equipment policy developed by regional carriers. Coordinated with CMS regional staff to ensure that carriers operated within regulatory guidelines. Assisted in coordination of annual national meeting for contractors and medical directors. • CMS Office of Budget. Developed, planned, and published the FY 1994 Chief Financial Report. Assisted in development of annual Medicaid budget. • CMS Centers for Medicaid & State Operations. Assisted in review and development of various State healthcare demonstration proposals and participated in technical review panels.