Provide consulting services to assist healthcare providers, community service agencies, and state and federal government clients on healthcare related service delivery, financing and operations. Initiatives are focused on health system transformation and implementation of new and existing policy guidelines for all payers, with an emphasis on Medicaid and Medicare systems and approaches, including organizational effectiveness, Medicaid Reform, payment transformation and revenue cycle management.

Provided project management and consulting services to assist state and federal government clients on healthcare related service delivery, financing and operations, specifically health system transformation and implementation of new guidelines under the Affordable Care Act (ACA) for all payers, with an emphasis on Medicare and Medicaid systems and approaches. Engagements included organizational effectiveness, Medicaid Reform, payment transformation, program integrity, managed care, and the… Show more Provided project management and consulting services to assist state and federal government clients on healthcare related service delivery, financing and operations, specifically health system transformation and implementation of new guidelines under the Affordable Care Act (ACA) for all payers, with an emphasis on Medicare and Medicaid systems and approaches. Engagements included organizational effectiveness, Medicaid Reform, payment transformation, program integrity, managed care, and the State Innovation Models initiative. Show less

Provided program integrity consulting for healthcare managed care organizations and government payers. Previously, as Sr. Policy Specialist for Medicare and Medicaid, provided reimbursement subject matter expertise, policy support and provider contract interpretation to the Fraud, Waste, Abuse and Error (FWAE) Unit in the identification and recovery of improper provider payments for United Healthcare product lines. These include Medicaid Managed Care, Medicare Advantage and Commercial lines… Show more Provided program integrity consulting for healthcare managed care organizations and government payers. Previously, as Sr. Policy Specialist for Medicare and Medicaid, provided reimbursement subject matter expertise, policy support and provider contract interpretation to the Fraud, Waste, Abuse and Error (FWAE) Unit in the identification and recovery of improper provider payments for United Healthcare product lines. These include Medicaid Managed Care, Medicare Advantage and Commercial lines of business. Show less

Provided quality and risk management oversight of federal healthcare claiming projects, including Medicaid administrative claiming on behalf of schools and community-based mental health centers. Designed, developed and implemented community-based Medicaid administrative claiming on behalf of several state Medicaid departments. Provided executive account management and oversight of several large scale multi-faceted projects on behalf of several state Health & Human Services divisions.

Managed the Financial and Program Knowledge Units supporting the Medicaid administrative and fee for service reimbursement programs on behalf of schools and Mental Health Centers nationwide. Negotiated federal program approvals with the Centers for Medicare & Medicaid Services (CMS), drafting audit responses, policy white papers and contributing to the final version of the CMS School Based Administrative Claiming Guide.