Linda Vespie Email & Phone Number

Atlanta, Tx, Us

Oversaw Medicare and Medicaid compliance with agency regulations to minimize the risk of exposure, fines, and sanctions; analyzed, researched, defined, and interpreted regulatory requirements, built solid relationships with internal and external stakeholders, and managed product teams. ▪ Architected and Administered a Framework of Compliance that adhered with laws and organizational regulations.▪ Steered the Product Management Team to Deliver Innovative Solutions consistent with Medicare and Medicaid Services (CMS) regulatory requirements. Held responsibility for Scrum teams and the Agile process. ▪ Directed Internal Audits and Investigations with sensitivity and confidentiality to identify Medicare and Medicaid compliance issues/deficiencies and implement corrective action plans.▪ Empowered the Medicare and Medicaid Audit/Compliance Team to Exceed Established Objectives, perform all operations with high levels of integrity and commitment, and proactively overcome barriers by providing training, communicating consultative feedback, and recognizing top achievements. ▪ Aggregated, Analyzed, and Managed Market Data to develop roadmaps, action plans, and assessments that increased the competitive edge of the firm. ▪ Authored New Compliance Documents and shared the requirements and completion processes with product teams.

Responsible for Medicare Advantage, Medicare Part D Enrollment Solution including creating business requirements for CMS Compliance & to increase product competitiveness.

Responsible for Sales Support of Medicare Solution Applications, including product demonstrations and value proposition for current and prospective clients both onsite with the Client or via web. Provide product enhancement opportunities to development staff, testing demo servers, and respond to RFP and RFI requests.

Up State Ny

Acting Director of Enrollment for an East coast health plan, supporting Medicare, Medicaid, and Commercial lines of business. Responsibilities included providing process improvement oversight. Created Standard Operating Procedures while providing staff training. Preformed Mock CMS Audit and provided action plans for deficient audit areas.

Houston, Tx

Responsible for managing 100+ direct reports including off shore staff to implement process improvements for a Private-Fee-For-Service Medicare Advantage plan while ensuring compliance with CMS regulations. Streamlined operational efficiencies to maintain an efficient day-to-day work flow of enrollment and reconciliation transactions for the Medicare line of business. Developed a second tier resolution team to research and resolve provider and member issues to reduce the number of issues presented to the plan. Developed a training plan as increasing the accuracy of enrollment transactions. Liaison with Marketing, Information Technology and Compliance to ensure strict regulatory guidelines are met. Provided business requirement documents to IT Development staff for creation and enhancements of web-based applications. Improved department policies and procedures including instituting internal controls and reporting. Participated in implementation of three new MA-PD products, one new ESRD Demo Plan and two PFFS MA and MA-PD plans. Participated in systems conversion to Facets. Groomed numerous employees to achieve high personal goals.

Flint, Mi

Development of Standard Operating Procedures and Policies and Procedures. Recouped lost revenue from CMS due to membership discrepancies. Analyzed CMS Weekly and Monthly Transaction Reply Reports and created Management reports. Creation and submission of model and non model letters to HPMS. Performing data analysis on incoming and outgoing files, including: Weekly Transaction Reply Report,Monthly Transaction Reply Report, Monthly Membership Report, MPWR (Monthly Premium Withholding Report), Special Transaction Reply Reports, Bi-weekly LIS Files (Low Income Subsidy). Acted as Project Manager for Medicare Part D implementation. Implemented system improvements to comply with CMS changes. Preformed Second level CMS audits. Ensure enrollment compliance with State and Federal regulations. Develop and maintain working relationships with IntegriGuard, CMS Regional and Central Offices, and Infocrossing. Implementation of Membership and Revenue Reconciliation process with vendor for monthly plan reconciliation. Work closely with IS&T Department to develop daily error reporting, monthly financial reporting and staff production logs.