Seth S. Email & Phone Number

Toledo, Oh, Us

Primary responsibilities include overseeing compliant implementation of health insurance regulations, supporting audit readiness, and analyzing compliance program reports.Key accomplishments:• Secured vendor agreement to implement the Medicare Prescription Payment Plan by presenting regulatory and operational requirements to senior leadership and key stakeholder workgroups.• Enhanced CMS program audit readiness by performing quality reviews of universe data and analyzing compliance monitoring reports to identify instances of non-compliance. • Analyzes CMS regulations and provides actionable recommendations to operational teams and product leadership, ensuring compliant implementation and alignment with regulatory requirements.• Manages a project plan to develop and implement 1557 policies, notices, and training in compliance with the 2024 final rule.

Toledo, Ohio

Reporting to the Manager of Regulatory Affairs, responsibilities included executing regulatory filings for government funded products, developing plan documents, and disseminating CMS regulations. Key accomplishments:• Facilitated regulatory filings for 12 Medicare Advantage Prescription Drug plans by collaborating with product leadership to develop plan benefit packages.• Executed service area expansion of 3 CMS Medicare Advantage Prescription Drug plan contracts, resulting in the addition of 40+ new counties to the product portfolio.• Developed the Evidence of Coverage, Annual Notice of Change, and Summary of Benefits for 12 Medicare Advantage Prescription Drug plans by utilizing Simplify document generation software.

Toledo, Ohio

Reporting to the Fitness Operations Manager, effectively developed key relationships with system providers, enhanced clinical outcome data collection, and managed accreditation audit readiness.Key accomplishments:• Implemented a fitness assessment system to produce clinical outcome data for 50+ annual medical fitness program participants.• Supported integration of medical fitness programs to EPIC electronic medical record system to establish continuous lines of communication with 20+ referring providers.• Spearheaded 2018 Medical Fitness Association re-accreditation audit, successfully achieving a 98% passing score.• Directed development of an online member portal by collaborating with software developers, effectively streamlining member management for 500+ facility members.

Bachelor'S Degree, Exercise Physiology

Master Of Public Health - Mph, Public Health Policy And Law