Over the past two years I have held various positions depending on the current contracts:Manage approximately 100 consultants assigned to review Medicare Advantage and Medicare Prescription Drug Plans in 25 of the western states. Assign shops, interact with shoppers, review data from their encounter, maintain records and report findings through various records systems and weekly conference calls with CMS both central and regional offices.Work with data analysts, statisticians, regulatory analysts, and other team members to define potential areas for analysis. Review hypothesis prior to testing to ensure the capture of appropriate elements to be included in the data run/test.Audit of compliance programs for Medicare Advantage and Prescription Drug contractors that hold government contracts to insure compliance with contracts and requirements. Includes evaluating overall compliance with enrollment and all areas of operation with contracts and the evaluation of subcontractors.Review results, analyze and provide comments, recommendations for further efforts, interpretations and/or conclusions. Identify and share best practices..

Managed complex high priority producer certification project for Medicare for four states for Blue Cross and Blue Shield Medicare products – Illinois, New Mexico, Oklahoma and Texas. Project involved approval and coordination with State Insurance Departments and federal requirements for sales, marketing, and claims processing for medical and drug claims depending on the product lines in each state.Marketed products through advertising agencies and through web and printed information coordinating with all internal staff and acquiring necessary government approvals for web sites and materials.Prepared manuals for providers and producers, and internal staff. Worked with contractor to establish a Secret Shopper program for sales in all four states and evaluated results working with state sales managers when necessary after shop.

Evaluated and selected PSC from competitive bid process.Project Officer for benefit integrity work in 11 states with over 33% of total Medicare beneficiaries. Included setting up of the PSC from traditional contractors, interacting with Dept of Justice, FBI, and State Medicaid fraud units. Contracts included 2 PSCs and Coding Contractor for Durable Medical Equipment nationwide.Statement of work and contracts were evaluated. Insured deadlines were met or exceeded and that the budget allocation was appropriate.

Directed Regional Education for Medicare beneficiaries advising of choices in health care options for 5-state region which represented approximately 10% of the national beneficiaries. Managed the work teams that coordinated with state agencies, insurance companies, Depts. of Insurance all states, and other partners. Developed partners and coalitions that had a significant effect on the health program of seniors. Staff was responsible for all beneficiary inquiries to the government office from the 5-state region including Congressional inquiry and critical cases referred from White House or other critical areas.Staff was responsible for all fee-for-service appeals for Medicare claims. Also responsible for the Contractor Performance Evaluation process. Responsibility included varied functions but brought the various functions to work together as a team.

Directed user group for the Arkansas Part A Standard System maintained by Arkansas BCBS. (At time of oversight processed 40% of all Medicare Part A claims on the system.) Interfaced with Central Office (CO) and 10 regions keeping them informed and up to date on systems issues. Duties included analyzing issues and problems to resolve claims or customer service issues. Many providers felt the system met their needs. Developed and implemented professionals relations and established activities to maintain an effective working relationship with provider and other professional organizations.Directed user group for the Medicare Standard System (MCS) maintained by EDS. (At the time processed claims for 30% of all Medicare Part B claims.) Managed budget and policy issues of group. Because of my exemplary performance, user group made special arrangements to retain my oversight of the group several years after the term had expired.Known nationally for the outstanding job working with these groups. Analyzed systems and made recommendations for improvements. Interpreted policy and evaluated contractor operations.Directed a workgroup for major national computer project. The workgroup included staff from regions and CO and contractors to provide a comprehensive report of edits and exceptions for Medicare systems. This was a key project for CMS requiring highly technical and complex negotiations with all parties to reach the desired goals. Proactive and willing to take on problematic issues. Reported after CO detail – Her knowledge of systems and the Medicare program greatly added to our ability to deal with these issues.Directed contractor for the Medicare Customer Service Center Project from inseption to acutally rolling out the initial work station.

Responsible for management oversight of insurance companies contracting with HCFA. All phases – budget, operations, regulatory compliance and resource.

Staff was responsible for all administrative functions of the region from mail to funding of operations. Region included 225 employees (primarily located in one location). Responsible for regional management of staffing, space, personnel including adverse actions and promotions, travel expense, labor relations, the administrative operational budget.