Randi Heitzman Email & Phone Number

United States

Albany, New York, United States

New York, United States

United States

Expanded role from Cigna+Oscar Health Plan Counsel to becoming Director, Northeast Health Plan Counsel and a managing attorney in less than a year• Partner with various team to provide strategic and legal guidance on a range of regulatory matters, including proactive identification and assessment of regulatory risks, with specific focus on the C+O small business product in all states the product is offered, Oscar’s Northeast states, ERISA, MHPAEA, NBPP rules, exchange rules, as well as matters related to the pharmacy department, concierge department, appeals and grievances department, utilization management department, and marketing department• Provide thought leadership on regulatory and industry developments, including the proactive identification and assessment of regulatory risks and the ongoing monitoring/tracking of relevant regulatory updates• Analyze and distill complex legal issues into easily understandable content for the operations teams and key stakeholders across the company• Provide day-to-day legal advice related to the individual lines of business and small group lines of business, and serve as legal advisor on matters before the state and federal agencies• Managing a junior attorney in a new management structure for the legal department

Albany, New York Area

Reorganized the department to improve efficiencies and create the company’s first ever Marketplace Facilitated Enrollment Program• Oversaw a staff of 30 employees, including 2 supervisors and 2 managers• Reversed the trend of enrollment loss to enrollment increases• Implemented and maintained a call center for enrollment in the NY State of Health and managed an external outreach team• Worked with community-based organizations, provider offices and county clinics to assist in enrollment and community-based needs• Developed a financial reconciliation process with the finance department to ensure payment by the state, preventing over a $2 million loss and improving the process to ensure timely payment by the state• Established and lead the Mandates Project, which is responsible for ensuring all laws and regulations get implemented companywide

Albany, Ny

Established the Plan Management Bureau for the NY State of Health within the NY Department of Health• Created policy and recommendations to leadership for health plan participation in the NY State of Health, including assisting the Department of Financial Services and other Bureaus at the Department of Health in creating policy for the health insurance industry• Lead the implementation and operational efforts for health plan participation, including drafting the Plan Invitation and Qualified Health Plan contracts, overseeing, and managing the technical development and maintenance for the qualified health plan and dental plan components of the exchange• Established and managed a team of 13 employees who acted as health plan contacts• Represented the Executive Director with federal authorities, NYS legislators, other NYS agencies and health plans

Schenectady

Taught M.B.A candidates about how policy is formed, including the state and federal legislative and regulatory processes• Designed the course, curriculum, and exams to advance the student’s understanding of policymaking and the various stages of influence• Held interactive classes that included representatives from the legislature and regulatory agencies to provide a realistic approach to policymaking

Became the company subject-matter expert on healthcare reform and the Affordable Care Act• Provided guidance and recommendations on health care reform strategy to senior management and government agencies• Regular speaker at conferences, broker, and health insurance agent events• Assisted in the development of implementation plans for health care reform initiatives, including the health exchanges• Acted as liaison with state and federal agencies

Provided legal counsel on matters affecting strategic initiatives and day-to-day operations with a focus on Medicare and Medicaid compliance, laws and regulations• Served as the legal representative in the creation of the company’s first Medicare Advantage program and became the legal subject matter expert on Medicare• Counsel to the internal Special Investigations and Corporate Compliance units, where provided advice as well as provided a supporting management and operational role to the units• Represented CDPHP before state and federal agencies on matters involving compliance, complaints, audits, and fraud investigations• Drafted and negotiated contracts with providers and third-party vendors• Conducted legal research and analyzed the legal implications of proposed laws and regulations

Recommended and developed provider contract strategies after a merger among health insurers, and analyzed any regulatory or legal implications of such strategies • Provided legal counsel to the merged health insurer on a variety of matters, including compliance with Medicare and Medicaid laws and regulations, and NY State Laws and regulations.• Drafted and negotiated provider contracts• Conducted legal research and analyzed the legal implications of proposed laws and regulations

Jd, Cum Laude, Health Law Certificate

B.A., Biology/History, Philosophy