Vice President of Compliance Solutions

• Nov 2020 - Present

• Provide clients leading edge strategies and direct ACG teams that guide clients in federal and state regulatory matters, internal and external investigations, preparing for and conducting regulatory audits, filing state insurance and federal program applications along with the design and implementation of compliance programs. • Guide health plans in implementing effective partnerships between operations and compliance, in FWA program design along with delegate monitoring, auditing and oversight and implementing corrective action plans. • Provide guidance to health plans, sales organizations, behavioral health and provider organizations to design and operationally implement effective compliance solutions and manage regulatory relationships.

Vice President Compliance, Chief Compliance and Regulatory Operations Officer

• Mar 2019 - Jul 2020

• Member of executive leadership team reporting to the Board of Directors and CEO, responsible for the compliance and risk programs supporting Nebraska Medicaid’s Heritage Health Program. • Ensure business unit and Centene Corporate are in compliance with state and federal program regulations, insurance regulations, regulatory requirements for business entities and state contract requirements. • Maintain and track laws and regulations, contract documentations, amendments, and various compliance measures. Develop policies, procedures, and processes to comply with state law, federal law, contract requirements, and various standards. • Oversee, administer, and implement various compliance programs, including fraud and abuse and HIPAA. • Provide guidance to various departments regarding compliance issues and implementation of new compliance requirements with respect to regulatory and contract language. • Conduct compliance audits, develop and implement corrective action plans, and report on achievement of action plans to senior management and Board of Directors. • Develop strategic relationships with state legislative policymakers and assist with the development of state legislative public policy concerning state insurance, Managed Care Organization, and Medicaid regulations and initiatives. • Identify, evaluate and analyze the impact of state legislative and regulatory issues and advise management concerning impact. • Represent senior management at various committees, meetings, and seminars.

Vice President, Compliance, Privacy, & Security Officer

• Dec 2011 - Mar 2019

• Developed from inception and directed 5 departments: Corporate Compliance, Special Investigations Unit (FW&A), Internal Audit / Enterprise Risk Management, Business Information & IT Security, and Employee Assistance Program Claims Payment. • Reporting to the Board of Directors and CEO, responsible for the enterprise-wide compliance and risk program supporting $100M in annual revenue & 20 million+ members, in all 50 states, including: Utilization Management, Case Management, Quality Management, Provider Credentialing & Network Management, Appeals & Grievances, Human Resources, Marketing, Employee Assistance Programs, Accreditation (URAC & NCQA), the Special Investigations Unit, IT Security and regulatory compliance in the commercial, Medicare Advantage, Medicaid, FEP and exchange lines of business. • Ensures the Board of Directors, management and employees comply with the rules and regulations of regulatory agencies, company policies and procedures, and the behavior in the organization meets the company’s Code of Ethical Business Conduct & HIPAA standards.

Manager of Performance Enhancement & Documentation for Senior Business Operations

• Aug 2009 - Dec 2011

• Reorganized and directed operational audit program of the senior business division and oversaw two remotely located departments supporting 37 direct reports: 33 Quality Auditors performing regulatory and operational audits and 4 Sr. Process Experts in creation and improvement of divisional workflows, policies and procedures. • Oversaw auditing of operational staff against standards issued by the Centers for Medicare and Medicaid Services (CMS), senior business compliance, corporate compliance, service level agreements and the Blue Cross Blue Shield Association. • Managed quality audit reporting dashboards and used the data to identify and recommend process improvements, training and performance opportunities of 7 internal operational areas and 2 external international vendors of the senior business division. • Managed complex and highly visible divisional implementation projects.

Business Process Improvement & Strategy Consultant

• Jul 2008 - Aug 2009

Provided health plan clients regulatory and technical expertise in the adaptation of process improvement methodologies, standards and guidelines for multiple cross-functional projects and initiatives. Provided health plan clients regulatory and technical expertise in the adaptation of process improvement methodologies, standards and guidelines for multiple cross-functional projects and initiatives.

Compliance Officer & Quality Assurance Manager

• Sep 2007 - Jul 2008

Bloom Insurance Agency, an insurance services company, is divided into two primary verticals: a technology services vertical focused on providing technology solutions to the insurance industry and a contact center vertical, providing experienced Licensed Agents to the insurance industry with a special expertise in Medicare, Marketplace, Individual health, and ancillary products. Bloom Insurance Agency is licensed in all 48 contiguous US states. Bloom Insurance Agency, an insurance services company, is divided into two primary verticals: a technology services vertical focused on providing technology solutions to the insurance industry and a contact center vertical, providing experienced Licensed Agents to the insurance industry with a special expertise in Medicare, Marketplace, Individual health, and ancillary products. Bloom Insurance Agency is licensed in all 48 contiguous US states.

Office Manager & Physician Residency Coordinator

• Apr 2006 - Sep 2007

Division of Medical Genetics and Genomic Medicine Division of Medical Genetics and Genomic Medicine

Claims Processor & Clearance Specialist

• Sep 2004 - May 2006

Specialty Pharmacy & Home Infusion Therapy Specialty Pharmacy & Home Infusion Therapy

Front & Back Office Primary Care

• 2002 - 2004

Multi physician primary care office Multi physician primary care office

Front Office Medical Receiptionist

• 2001 - 2002