• Build and maintain strong relationships with relevant internal and external stakeholders, including federal and state regulatory entities.• Lead the implementation of the Part D PACE Program with the Pharmacy Benefit Manager.• Support and facilitate the development of various compliance program metrics, dashboards, key risk/performance indicators and other measures.• Stay abreast of standards and requirements including all relevant laws, rules, industry standards and company practices to cascade information to key contacts companywide.• Coordinate compliance strategies to manage regulatory risk, oversee the implementation of new state/federal regulations and advise business areas of best practices.• In collaboration with members of the Legal Team, manage the implementation of state/federal regulations. • Prepare reports and presentations required by the Compliance Committee, Executive Leadership, and the Board of Directors regarding compliance activities.

• Serves as a subject matter expert on Medicare compliance matters; delivering relevant regulatory compliance guidance in a concise, meaningful, and actionable manner and collaborating with business areas, IT, and/or FDRs to execute on Medicare compliance requirements.• Evaluate severity of risk, identify root cause and make recommendations to correct non-compliance processes in conjunction with current federal and state regulatory requirements in the Medicare and Medicaid lines of business. • Designs, develops, implements, and evaluates audit, monitoring, and assessment tools and evaluation processes. Conducts audits in accordance with the Compliance work plan.• In conjunction with the Chief Compliance Officer, oversees external regulatory and enforcement actions (i.e., data requests, audits, etc.)• Successfully lead the implementation of a new Pharmacy Benefit Manager (PBM) to handle prescriptions, grievances, appeals and FWA for members as well as assist with CMS Medicare BID cycle.

• Responsible for hiring, performance management and coaching/mentoring/training of staff to enhance professional development.• Review, analyze and validate monthly, quarterly and annual regulatory reports for submission to DOH and CMS.• Successfully remediate and closed over 13 deficiencies to date from 2020 internal and external audits. • Operationalize Compliance policies by leading in the design, development, and implementation of more than 12 SOPs and controls.• Responsible for strategic hiring, performance management and coaching/mentoring/training of staff to enhance professional development.

• Identify potential risk related to the current Utilization Management/Appeals and Grievance processes for the Commercial, Medicare and Medicaid line of business.• Collaborate with Corporate Compliance/Regulatory to evaluate adherence, as well as develop and execute improvements.• Implement monitoring tools for efficiencies within the audit process for over 10 processes related to auditing and risk assessment activities.• Manage departmental projects, workflow processes, policies and procedures in collaboration with internal and external stakeholders.

• Lead complex investigations and documents findings of the Pharmacy Benefit Manager (PBM) handling of member’s prescription. • Maintain reference guides, work instructions, and/or policies and procedures of over 20 documents to ensure successful knowledge transfer and mastery of concepts and processes.• Manage the collection and validation of all required Annual Reporting for Part D programs. • Complete targeted monitoring of coverage determinations, redeterminations and grievances to ensure compliance with the Centers for Medicare and Medicaid Services (CMS) and NY Department of Health (DOH) regulations.• Serve as Pharmacy Department’s Privacy Ambassador to ensure Compliance and HIPPA standards are followed.

• Coordinate with Account Management and Implementation Teams to gather product design requirements.• Outline end-to-end process for over 50 government program activities (Medicare, Medicaid and Healthcare Reform). • Project Leader to coordinate over 100 documents in the writing, editing and revising of job aides, work instructions and operational processes.• Review and update all 30 Medicaid policies annually, ensure they are compliant with current regulations, business unit processes and contract agreements for approval by internal Legal Counsel.• Maintain data maintenance and report generation to illustrate productivity.• Operationalize Compliance policies by leading in the design, development, and implementation of more than 25 SOPs and controls.• Provide weekly status updates to Senior Leadership.

• Define and document over 25 business processes and requirements to gain efficiencies. • Collaborate and problem-solve cross-functionally with internal business partners. • Employ new business practices to improve operational delivery.• Maintain daily/weekly/monthly data maintenance and report generation to illustrate productivity.

• Qualify over 150 orders weekly and assign new projects based on client budget.• Run daily report from Business Objects systems for Search Engine Optimization (SEO) & Pay Per Click (PPC) orders.• Validate and QA sales orders in excess of $100,000 to report on Finance Scorecard.• Execute and maintain quality assurance policies, Standard Operating Procedures (SOP) and metrics.

• Manage 50 clients monthly with communications, conflict resolution and compliance to create a positive customer experience and emphasize value.• Aid lawyers and law firms in marketing themselves to potential clients.• Provide direct telephone and email support of over 100 client communications while answering questions on billing, shipping, Editorial and website support.• Monitor customer and management complaints regarding the quality of products and/or services.