PerformCare was founded in 1994 by a group of leading behavioral health organizations, including providers and related associations. It is a full-service managed behavioral health care organization that supports members and providers. PerformCare offers specialized behavioral health and human services programs in both the public and private sectors. PerformCare is a wholly-owned subsidiary of AmeriHealthCaritas.Responsible for providing strategic direction and leadership for the development and implementation of compliance policy, process, and control activities and provides oversight of all operating division and subsidiary compliance, privacy, and regulatory functions.• Responsible for developing compliance methodologies to test established and newly executed operational processes and controls and monitor effectiveness.• Responsible for proactively identifying process gaps, weaknesses, and deficiencies in existing business processes and assist identifying opportunities for efficiencies.• Partner with local and corporate counterparts to develop protocols that support the review and assessment of objectives that ensure compliance with local plan and corporate policies and procedures.• Responsible for developing and monitoring metrics relating to fraud, waste and abuse reporting.

Adjunt Professor of Health Law & Ethics, an advanced level course for undergraduate students pursuing degrees in the healthcare field.

Established to deliver quality healthcare in the state of Pennsylvania through local, regional and community-based resources, PA Health & Wellness is a Managed Care Organization and subsidiary of Centene Corporation. Responsible for serving as the state liaison for coordination of overseeing all plan compliance, audit, and monitoring activities with state regulator entities to ensure timely responses to requests and manage risk. • Served as primary contact for state and federal regulators, responsible for documenting and inventorying any risks or sanctions received by the plan and ensuring they are adequately reported throughout the organization and timely responses were provided and any necessary corrective action plans are put into place and monitored. • Responsible for establishing and internal Policy Committee and mainlining the Plan’s policy manual including the coordination of the required annual review of all policies by the business owners throughout the organization.

Formerly Gateway Health Plan, Highmark Wholecare was founded in 1992, Gateway Health Plan was established as an alternative to Pennsylvania’s Department of Public Welfare’s Medical Assistance Program. Today, Gateway offers a variety of health plan options for beneficiaries eligible for Medicaid or Medicare and has become a top-ranked managed care organization that serves more than 300,000 members.Responsible for serving as the primary contact with state regulators and for program management of compliance related projects conducted by assigned business owners for state and federal regulatory requirements pertaining to the company’s Medicaid contracts.•Served as the primary contact for state and federal activities that are company-wide in nature and accountable for coordination of activities with multiple departments, business areas, external vendors and consultants.•Lead, coordinates and oversaw the development, implementation and on-going monitoring and follow through for Medicaid compliance program initiatives. Based on trends and issue identification, partner closely with business owners and organizational leaders to improve regulatory compliance, provide recommendations and ensure compliance measures are aligned, sustainable and operating effectively. Coordinate compliance operations with business units, including internal staff and/or external regulators to meet state and federal audit requirements.• Provided ongoing direction and support to business owners and management on compliance matters and coordinate inquiries with external stakeholders/consultants to resolve complex compliance issues.

Highmark Inc. is a national diversified health and wellness company based in Pittsburgh that serves 34.4 million people across the United States through its businesses in health insurance, dental insurance, vision care, information technology and integrated health care delivery. The company, which has more than 20,000 employees, is among the largest health insurers in the U.S. and the fourth-largest Blue Cross and Blue Shield-affiliated company.Provide expert consultation and impact analysis on federal and state health care reform legislation, regulation, guidance and exchange activity to support strategy and product development, operational and systems decision-making and ultimate positioning of the business to compete in regulated markets.

The position effectively represents the corporations’ interests and concerns by analyzing legislative and regulatory proposals, public policy issues, and other initiatives that affect the corporation, its subsidiaries, and the health care industry. This includes advising the corporation of policy and regulatory issues related to new insurance products, mandates, regulations and provider networks, and helping to find solutions and assure Highmark’s compliance with regulatory requirements.

Central Penn College is a career-oriented, baccalaureate, residential college in the suburbs of Harrisburg and offsite locations in Lancaster and Bethlehem, Pennsylvania. Central Penn College offers bachelor's and associate degree programs for both traditional and continuing education students by providing hands-on and online distance education taught by experienced, caring faculty.Course: Insurance & Risk ManagementFall Term 2011Summer Term 2015This course covers vehicles of risk management through insurance concepts including personal property, commercial property, and life and health. Most individuals, families, and businesses have a strong desire for financial security and protection against those events that threaten their financial security. For most people and companies, insurance is the major technique for handling risk.

Central Penn College is a career-oriented, baccalaureate, residential college in the suburbs of Harrisburg and offsite locations in Lancaster and Bethlehem, Pennsylvania. Central Penn College offers bachelor's and associate degree programs for both traditional and continuing education students by providing hands-on and online distance education taught by experienced, caring faculty.Course: Insurance & Risk ManagementFall Term 2011Summer Term 2015This course covers vehicles of risk management through insurance concepts including personal property, commercial property, and life and health. Most individuals, families, and businesses have a strong desire for financial security and protection against those events that threaten their financial security. For most people and companies, insurance is the major technique for handling risk.

MetLife is a leading provider of insurance and other financial services to millions of individual and institutional customers throughout the world. (My position was eliminated in 2010 due to an office merger and reduction in force.)Responsible for managing our local office's compliance with state and federal insurance and securities laws and regulations, for acquiring, training, motivating, and supervising a staff of seven professional employees, overseeing the new business processing team to ensure timely placement of business, and managing the agency's annual budget and expense allowances. In this position, I was responsible for working with the Managing Director in order to establish a business plan for the firm and work towards achieving the agency goals in all areas including production, recruitment, compliance, and profitability.Established new office procedures relating to purchasing and managing expenses to ensure the agency operated within the established budget and was able to reduce the office's monthly operating expenses by over $500.00 by successfully negotiating with local service vendors.Created an agency training binder for new sales representatives in order to assist them in navigating the proprietary applications, operational processes, and compliance procedures to ensure that their business was processed in a timely manner thus increasing overall compliance with company rules and procedures.Implemented monthly internal review systems to ensure the office received the highest possible rating on its annual internal compliance audits.Increased the agency's percentage of "good order" application processing by creating and implementing additional training for clerical staff and sales personnel resulting in faster processing speed for agency business.

The Northwestern Mutual Financial Network is considered to be one of the nation's largest direct providers of individual life insurance and rated one of the Top 10 independent broker-dealers.Responsible for recommending, developing, and implementing goals, strategies, and training pieces to improve compliance and supervision within the Network Office. These measures resulted in the office receiving exemplary ratings on its internal compliance audits. My main duties also included developing and administering procedures to assure that day-to-day sales and related service activities comply with all applicable laws, regulations, and Company rules. Created an agency training program which became required curriculum for all new and existing sales representatives to instruct them on the company's investment platform account registration requirements and compliance document retention rules in order to ensure that the individual representatives and the network office had met all regulatory books and records requirements.Elevated the network office's internal audit compliance "grade" from near failing to the highest achievable score in my first full year in the position; this score was maintained for the entire length of my employment.

The Pennsylvania Securities Commission administers and enforces rules and regulations under the Securities Act of 1972, the Takeover Disclosure Law of 1976, and subsequent amendments to those laws.Responsible for reviewing exemption and registration filings made to the Commission for compliance with State regulations and for corresponding with issuers to ensure compliance with disclosure and merit standards as outlined in the Pennsylvania Securities Act and its regulations.Involved in special revision/editing project of the Pennsylvania Securities Act and its corresponding regulations to correct "statutory loopholes" and address new issues that had arisen based on changes in the securities law environment.

The Workers' Compensation Appeals Board is responsible for researching and applying relevant statutory, regulatory, and case law to the facts at issue in the matters under review and drafting administrative opinions for review, approval, and publication by the Board Commissioners.