Lori Stiffler Email & Phone Number

Orange County, California, United States

► Develop, implement and provide ongoing oversight of the Contracting department's regulatory compliance activities► Identify and report issues of compliance and develop/recommend solutions and corrective actions to ensure the Contracting department complies with all internal and regulatory requirements► Oversee special projects and new initiatives.

Long Beach, California, United States

• Directed the Medicaid Compliance department initiatives for the KY, TN, and WV markets with 10 direct reports while serving as Plan Compliance Officer for the Tennessee health plan.Selected accomplishments:
• Led cross-functional teams, ensuring compliance with 18 managed care contract amendments across multiple member populations (Medicaid, SCHIP, LTSS, and Dual-eligibles).
• Reviewed and provided regulatory / compliance guidance on each section of Request for Proposal (RFP) response, resulting in retention of 500K TN members.
• Integrated compliance principles into strategic initiatives through active participation in various committees, such as Quality Management, Operations, Network Management and Special Investigations Unit.
• Optimized Compliance staff during staff transitions by identifying talents and redistributing responsibilities.

Long Beach, California

• Executed compliance activities to support corporate and the Tennessee health plan operations to ensure regulatory and contractual adherence to state and federal requirements.Selected accomplishments:
• Collaborated with company leaders, implementing new Long-Term Services and Support product that resulted in 1K members and State Children’s Health Insurance Program (SCHIP) that added 15K members.
• Advised leadership of state mandates during COVID pandemic, guaranteeing compliance in evolving regulatory environment.
• Fostered compliance and company success by developing and maintaining strong relationships with state personnel and company leaders.

Orange County, California Area

• Developed programs and strategies to apply contracted rates and state Medicaid reimbursement policies accurately. Managed multiple markets across matrix organization, including AZ, KS, NM, OH, TN, TX and WI. Led team.
• Researched reimbursement methodologies, directing system configuration and creating provider contract language.

Reviewed and interpreted state and federal regulations, legislation, and state Medicaid contracts to communicate provisions, educate staff, and evaulate company compliance.