Centene provides services to approximately 11 million people across 28 States in government-sponsored healthcare programs and implementations. Bridgeway Health Solutions is a managed care health program that provides services to 6,000 individuals enrolled in the Arizona Long Term Care Services (ALTCS) plan. Bridgeway also offers an aligned Dual-Eligible Special Needs Plan (D-SNP). Cenpatico Integrated Care (CIC) offers a large network of behavioural and health providers across southern Arizona. CIC provides services to over 440,000 individuals. CIC provides whole person healthcare to individuals designated as having a serious mental illness. CIC provides behavioural health and integrated care for eligible populations. Health Net of Arizona Inc. and Health Net Life Insurance Company deliver managed healthcare services through small and large group commercial and Medicare health plans. Health Net Access provides managed care services in Arizona for about 60,000 Medicaid members in Maricopa County.In the role of the Arizona product Compliance Officer, responsible for the implementation, documentation, and maintenance of a coordinated legislative and regulatory compliance program that meets the expectations of State and Federal regulators and corporate Government and Commercial Programs meeting all 7 compliance program requirements recommended by the US Sentencing Guidelines including a comprehensive fraud, waste and abuse program. Key accomplishments include: the expansion of an effective compliance program, policies & procedures, educational program, delegated vendor oversight, auditing & monitoring program, cultural competency program and privacy program policies and procedures.

Monitored the performance of the health plan’s compliance program on an ongoing basis, taking appropriate steps to improve effectiveness for all operational areas including claims, encounters, pharmacy, medical management, quality management, contracting, provider relations and member services. Key accomplishments include adoption of Medicare Advantage policies and procedures, development of an enrollment/disenrollment reconciliation process and creation of compliance warehouse in coordination with Information Technology Department to enhance ability to track Medicare and Medicaid contract compliance.

Developed and maintained productive relationships with all levels of management as well as legislators, regulators, and other relevant internal and external parties to effectively incorporate the compliance program in coordination with the department director. Promoted from Appeals Coordinator to Compliance Manager after two years. Responsible for initial CMS Special Needs Plan application process including onsite readiness review and served as liaison for annual audit. Key accomplishments include management of the plan’s small business insurance product, development of a special investigation process to compile potential fraud, waste and abuse reporting the State and implementation of all staff training on Medicare contract policies and procedures.