Deborah Robinson Stewart Email & Phone Number

Wayne, Pa

Business lead, subject matter expert and thought leader on Medicare and managed care compliance. Track, analyze, and communicate government payer regulations including Centers for Medicare and Medicaid (CMS) Parts B, D, and Advantage, Medicaid and policy impact to clients or other stakeholders. Routinely consult with clients to assess policy application and non-compliance risks. Direct the preparation of filings in accordance with CMS requirements and respond to CMS and Advantage Plan inquiries. Collaborate with product management and sales teams in the operational rollout of new client accounts and support for existing clients. Provide on-site/virtual client and internal staff continuing education compliance trainings.

Regulatory advisor participating in Administrative Law hearings involve healthcare payer disputes via the Office of Medicare Hearings and Appeals. Prepared pre-hearing memorandum, position briefs and conducted regulatory research. Conducted conflicts check. Collaborated with Chief Medical Advisor on treatment guidelines and issues of medical necessity. Assisted with HIPAA audits and development of compliance monitoring protocols.

Supervised and coordinated a team of 9 appeal officers deciding reconsideration appeals. Directed work assignments, deadlines, and appeal dismissal determinations. Performed Quality Assurance audits to ensure readability and appropriate inclusion of citations to policy/regulations. Conducted research and analysis of legal issues related to Medicare Coverage, medical necessity, asbestos, ingestion and exposure and overpayments. Participated in CMS program audits and assisted with implementation of corrective action plans.

Analyzed, reviewed and developed long term disability claims; represented claimants at Social Security hearings nationwide; review and analysis of medical records, deposition transcripts and vocational job summaries in preparation for hearings; advised clients on matters involving social security disability, workers’ compensation, COBRA, ERISA, Medicare, Medicaid, long term and state disability benefit plans.

Plaintiff firm specializing in personal injury, insurance coverage and domestic relations matters. Drafted and responded to pleadings and discovery requests. Represented client's at depositions, arbitration hearings and in family court. Prepared deposition summaries, Wills and health care directives.

Doctor Of Law - Jd

Bachelor Of Arts - Ba, Psychology