Jan Howell Email and Phone Number

Provide legal advice and compliance guidance to operational departments regarding pharmacy operations and pharmacy benefits management. Perform legal regulatory research for pharmacy operational departments to ensure internal operational compliance. Research pharmacy law related to specialty pharmacy regulatory inquiries, etc. Review pharmacy contracts with manufacturers, governmental entities, data aggregators, etc. Review pharmacy reporting, Business Associate Agreements, HIPAA authorizations, and ensuring all reporting complies with privacy requirements. Investigating compliance hotline tip inquiries to determine whether compliance, privacy, fraud, waste, abuse, or human resource principles were violated, and ensuring organizational compliance with applicable law. Process regulatory bulletins and handle state licensing efforts as requested to support compliance department.

Oversaw Medicaid eligibility appeals within the Appeals, Issues, Resolution Division, ensuring timeliness and accuracy of processing eligibility appeals, ensuring compliance with policies and procedures. Developed staff members to operate at higher level of effectiveness in processing appeals, ensuring efficient workflow at high-volume caseloads, and volunteered for additional eligibility appeals special projects.

Hospital revenue lifecycle specific to Medicaid and Medicaid Pending Accounts Receivables. Reviewed and identified opportunities created by health care reform to increase Medicaid Eligibility for hospital patients and hospital reimbursement for former self pay population. Created strategic Medicaid Eligibility Vendor strategy and drafted and negotiates contracts to optimize Medicaid Eligibility Vendors. Served internal client Shared Service Center operations departments to improve accounts receivable management related to Medicaid or Medicaid Pending.

Advised clients, researched legal issues, & drafted memoranda, briefs, pleadings regarding public health contracts, confidentiality issues, administrative, personnel, and environmental health law issues.

Project implementation of Medicare Medicaid Coordinated Care Office dual demonstration project based on three-party agreement with federal/state agencies. Research of Medicaid state policy in conjunction with project planning documents to develop general program materials, with consideration of community-based care.

Directly managed $30 million budget to ensure accountable expenditure of local government taxpayer dollars for local health care program. Optimized Medicaid grant funding opportunities. Developed value-based benefits design, created benchmarks, oversaw finances, personnel and program operations of local governmental assistance program serving low-income citizens, generally suffering from chronic illness, homelessness, and other complex factors. Successfully added value by increasing quality of care provided while lowering cost of care, leveraging meaningfully integrated, coordinated care systems. Developed industry standard benchmarks through the implementation of medical management software, claims processing system, and eligibility systems. Revised 350 provider/vendor contracts to include value-based purchasing and improve data analysis and quality management.Successfully increased employee trust levels and forged organizational stability, integrity, infrastructure, and group dynamic. Enriched employee capabilities, encouraging employees to gain new skill sets through increased service opportunities.

Acted as in-house legal counsel for health insurance plan providing advice regarding government contracts, vendor contracts, provider contracts, privacy, security, electronic health, and other miscellaneous issues. Provided direction to the Compliance Department to ensure compliance with regulatory agencies, interpretation of government contracts; compliance statutes & regulations; fraud and abuse regulations; privacy and security, audits. Provided oversight of Human Resources Department and created succession plan strategy to assist the organization with identifying and coaching tomorrow’s potential leaders. Successfully implemented pilot phase of organization’s mentoring program.

Promoted to Deputy Commissioner to advocate on behalf of a $4.6 billion department in executive level meetings, providing leadership and direction to internal departments & vendors, fielding issues with political, fiscal, and operational implications. Coordinated state executive agency departmental policy changes by collaboration with federal officials as based upon internal interpretation of state & federal laws, regulations, and reporting requirements. Responsible for multiple vendor procurement, contract oversight and monitoring. Served as Program Director for $300 million IT implementation. Led a large implementation team of internal IT consultants & managed national vendor team at executive & project detail levels. Directed legal compliance efforts for heavily regulated program. Interpreted state and federal healthcare laws, regulations, reporting requirements, State Medicaid Manual, HIPAA privacy compliance and state privacy laws. Oversaw staff and coordination of policy changes made through Medicaid State Plan Amendments, regulations, and legislation. Oversight of daily operational and personnel issues. Served in generalist capacity to provide administration of all divisions, functions, policies, procedures, regulations, legislative activity, and records management. Fielded internal and external inquiries. Managed personnel issues as necessary and represented Commissioner in departmental staff meetings to communicate with staff regarding upcoming events and policy changes.

Advised and represented cabinet departments and offices on healthcare regulatory and community-based services. Advised clients concerning adoptions, protective services, guardianship, public benefits, model procurement law, contracts, state personnel law. Advised clients regarding privacy law with focus on state open records laws, health privacy, HIPAA Privacy Rule. Directed client activity in implementation of HIPAA Privacy Compliance Project. Successful at Kentucky Court of Appeals in arguing that a social worker’s duty to investigate is subject to sovereign immunity. Reviewed and drafted contracts and state memoranda of agreement.

Researched state law and composed opinions and orders for the primary court hearing state administrative agency appeals, civil legal issues, and criminal proceedings. Accompanied and assisted state trial judge in all hearings and motion hours.