Dana Rodgers Email & Phone Number

Responsible for developing, leading, and implementing the Compliance Program to promote ethical behavior that moves Cotiviti forward in achieving its goals.Develop, initiate, maintain, and revise policies and procedures for the general operation of the Compliance Program and prevent unethical and illegal conduct.Lead compliance investigations by conducting interviews, documenting findings, and making disciplinary recommendations in consultation with Human Resources and Legal.Develop and delivering compliance training. Monitoring completion of required new hire and annual compliance and ethics training. Conduct third party assessments on potential vendors compliance programs. Recommend contractual and business process controls to mitigate potential compliance risk.Providing input to the Compliance Officer on regulatory and operational matters and identifying potential and emerging compliance issues.Assist with the development and execution of the annual compliance risk assessment and related work plan.Monitoring employee and third-party onboarding operations to ensure successful completion of OIG/SAM health care screenings.Monitoring investigations of conflicts of interest disclosed by employees and third parties during new-hire and annual training, including documenting findings and recommending appropriate mitigation activities.Support of the compliance committee, including producing associated compliance metrics and reports associated with these governance meetings.Supervise department staff responsible for the day-to-day activities of the Compliance Program

Greater Philadelphia Area

•Leads the Procurement Governance Workgroup to oversee the onboarding of subcontractors/vendors/FDRs to ensure all contractual, state and federal requirements are met. The following departments attend this meeting: Compliance, Legal, Delegation Oversight, Sourcing, IS Security, and Privacy. Continued monitoring of over 140 entities.•Issue internal and external corrective actions. Approve the remediation plans to ensure they resolve matters of noncompliance. Monitoring around 30 CAPs at any time.•Conduct compliance audits. This includes defining the scope of the audit, planning of the audit, presenting the information to affected departments, and issuing corrective actions as needed. Past focused reviews included topics regarding grievances, appeals, exclusion checks, and subcontractors-vendors compliance training. Assist in managing SOC II audits for Compliance Department.•Project manages external audit requests, reviewing deliverables, creating risk assessments, and prepare business owners for onsite audits.•Lead investigations on alleged violations of the Code of Conduct & Ethics. Conducted privacy inspections and conflict of interest reviews. •Participated in cross-functional readiness review work groups. This includes a review on new business implementation to validate all policies and procedures, communications (provider and member) developed, and other documents requiring state approval that may have contractual impacts or requirements whereby ensuring compliance with the RFP. Assisted with the maintenance and creation of a Master Log of all historical Fines, Sanctions, and Penalties for tracking over 2 million dollars in Fines, Sanctions, and Penalties. Worked with Legal and the Proposal Team to ensure RFP submissions were current and accurate. •Annually review and update the established written policies and procedures to enforce standards of conduct and promote compliance, including the employee guidebook.

Supports oversight of Medicaid and Medicare plans across multiple states by implementing compliance policies and monitoring activities. •Issue and monitor corrective action plans based on contractual guidelines and regulatory metrics. Evaluate and report on the same. Assess the risks associated with noncompliance and provide solutions to become compliant.•Conduct internal monitoring investigations to identify gaps or risks that would leave the company open to corrective action plans, audit findings, or sanctions and penalties.• Responsible for ensuring all subcontractor and vendors complete an Ownership Disclosure Form and compliance training annually and during onboarding. •Review and provide compliance feedback on documents submitted for audits.•Led company-wide webinar on the Corporate Code of Conduct and Ethics.

Greater Philadelphia Area

Supervising the Complaints and Grievances team, serving Medicaid plans across multiple states. •Ensures complaints and grievances are completed in accordance with our Service Level Agreements (SLAs), state laws and federal guidelines. Created and enforced desktop procedures to guarantee the same. Prepares analysis for NCQA and works with Regulatory Affairs for State reporting to demonstrate compliance. Selected to create desktop procedures for other department's reporting systems after establishing proven results in internal audits.•Communicates, implements, and maintains production and quality standards. Measures and reports my teams’ performance against our department's goals and objectives.•Conducts performance appraisals, coaching, performance improvement plans, and interviewing/hiring.

Investigate, evaluate, negotiate, and resolve attorney-represented, litigated and non-litigated, bodily injury claims, managing 150 claims at any given time. Confirm or deny coverage and liability and advise policyholders and claimants as to proper course of action. Advise defense counsel on the strategy to take, from discovery to trial, on litigated claims. Direct legal on steps to take with the claim, determine monetary worth, and assess risk. •Ensure adequacy of reserves by accurately assessing and predicting legal fees and value of the claim through research and review of files. Responsible for $500k total in reserves.•Represent the company at mediations, settlement conferences, and trials to mediate, negotiate and resolve positive outcomes for the firm. Resolve 97% of cases on average before trial. •Identify and recommend referral of potentially fraudulent claims to the SIU (Special Investigations Unit), cross-reference facts and affidavits, recognize and research red flags, and arrange for expert inspections and outside vendor investigations to avoid paying on fraudulent claims.

Determined if insurance companies were in compliance or violation of law by reviewing consumer complaints on claim delays/denials, underwriting decisions and policy enrollment and cancellation, and collaborating with actuaries, market conduct examiners and supervisors to determine compliance.• In 2 years, recovered more than $1,117,000 in insurance claims paid.•Attained a $250,000 benefit payout on behalf of a client whose money was being mistakenly withheld due to a processing error. Due to a pending foreclosure, the client would have lost her house without the payout.•Explained health and dental insurance contracts and fee schedules to patients and providers. Explained life insurance, credit insurance, annuities, accidental death policies, COBRA, HIPAA, and Continuation Coverage to consumers.•Drafted orders against insurance companies for violating the law. Drafted hearing requests for complainants going before Administrative Law Judges to help the public assert their legal rights.•Determined if a complaint is in the State of Maryland’s jurisdiction to ensure claims were handled properly and according to the appropriate State laws.

Jd, Law

•Business Law Concentration INTERNSHIPS: THE OFFICE OF THE ATTORNEY GENERAL, Baltimore, MD Summers 2006/2007 Law Clerk (Opinions.

Bachelor Of Science (Bs), Business Administration And Management, General

• Special focus on Human Resources • Minor in Philosophy