-Successfully led DHP’s 2022 CMS Medicare Program Audit in which the health plan received 0 findings or observations for the Compliance Program Effectiveness portion of the audit-Responsible for overseeing DHP's Medicare Compliance Program, inclusive of the following: developing the annual risk assessment and auditing/monitoring work plans, reporting compliance metrics and significant issues to board level committees, managing DHP's CMS Account Manager relationship, communicating/clarifying regulatory guidance to business areas, serving as the lead contact and subject matter expert for any external regulatory audits, and assisting in the preparation and review of annual compliance training materials

-Managed the day to day operations, compliance, and vendor oversight of DHP’s encounter data submission process-Redesigned DHP’s health risk assessment (HRA) to better identify Medicare Advantage members with potentially under-coded HCCs-Created a 2021 auditing and monitoring plan focusing on suspected issues with vendor encounter data submissions and mock RADV audits

-Designed and implemented DHP’s first Medicaid Compliance Plan which monitored, detected, and effectively remediated non-compliance in various operational areas such as claims and prior authorization processing-Developed a Medicaid risk assessment process which identified potential contractual risks and led to increased monitoring and auditing under the Medicaid Compliance Plan-Created a comprehensive oversight plan for DHP’s Medicare risk adjustment submission vendors which focused on regular monitoring and auditing to ensure CMS regulations and industry standards were met

-Led the Medicare CY2016 and CY2017 Data Validation process in which Security Health Plan scored 100% for both of its Medicare contracts in both years -Successfully managed the Medicare CY2018 and CY2019 Service Area Expansion application process which allowed Security Health Plan to offer Medicare Advantage plans in eight additional counties-Overhauled the Medicare EDPS error correction and error mitigation processes reducing the rejection rate from 3.72% in 2015 to 1.49% in 2017-Streamlined the Medicare RAPS submission and error correction processes leading to a 75% reduction in staff hours spent on these monthly tasks

-Developed and managed a monthly call campaign to Medicare Advantage members at the end of their premium grace period, effectively saving over 150 members from disenrollment in 2016 at a savings of $750,000 to the health plan-Established and oversaw a comprehensive call resolution coaching program which increased First Call Resolution from 80% in 2016 to 83% in 2017, leading SQM Group to recognize Security Health Plan as a finalist for their Call Center of the Year award-Successfully completed the first full year of the Customer Service bonus program which reduced staff turnover by 20% in 2016

-Designed, tested, and implemented a Customer Service bonus program which improved First Call Resolution from 75% at the start of the program to 80% by the end of 2015-Overhauled SHP's member email response process, improving production by 1.8 (5.5 to 7.3) emails per hour and quality by 7.4% (90.2% to 97.6%) from 2015 to 2016-Streamlined and centralized CSR level projects resulting in more consistent coverage and a reduction in yearly Average Speed of Answer from 6:04 in January of 2015 to 1:32 by December of 2015