Denver, Colorado, United States
Collaborates with leadership to align UPIC contracts between the Southwest and West regions, ensuring consistency and compliance across both contracts. Strengthens the appeals processes and provides legal guidance and advice to support program integrity and mitigate organizational risk. Contributes to new business development efforts, helping to secure multiple contracts in emerging areas of AI technology. Partners with more than 20 states across both UPIC regions to address Medicaid and Medicare fraud, waste, and abuse. Enhances Qlarant’s presence on the conference circuit, increasing organizational visibility and advancing the company’s mission. Collaborates with CMS to ensure continued oversight and safeguarding of funds across both Medicare and Medicaid programs.
FWA Division Director, Program Integrity Contract Oversight Section Manager, Audit and Compliance Division. The PI Section exists to improve provider billing integrity, investigate referrals, implement new PI projects, oversee managed care program integrity programs, investigate and determine if a credible allegation of fraud exists, conduct rule review to ensure rules are enforceable, and provide expertise and leadership to critical and complicate program integrity issues and develops and implements critical new projects.
Consulted on legal matters.
Conduct administrative hearings involving various hearing types for the Colorado Department of Revenue.
Worked directly with the office Director and Deputy Director to draft and implement policies and procedures for the day to day operations on the office. Tracked and coordinated all legislative, budget, and audit request that come into the office from external departments on both the State and Federal level. Co-drafted and monitored the CMS Federal Corrective Action Plan surrounding the Pueblo Regional Center investigation. Monitored the General Business Budget that exceeded 4 million dollars. This included tracking current expenditures, encumbrances, and overall use of funds. Handled specials projects for the Deputy Director as they arise, including responding to member appeals and stakeholder requests.