Semi-Retired adult & high school Vocational Educator; Pivotal Consultant, serving as a Talented Patient Experience Concierge within Appeals & Grievances capacities at a Senior level with ten years industry experience.
Ava directly impacts service recovery and retention rates in Medicare Advantage venues with deep Compliance & Auditing skills.
Gail’s experience includes 20 plus years working in health care as a compliance officer and consultant in the Medcare arena. As an experienced Compliance Officer for health plans her approach to compliance involves dedication of the entire organization. This top-down organizational approach ensures support and accountability from each staff member and assists the Compliance Department with implementation and management of the Plan’s Program. Gail’s responsibilities include implementing federal and state regulations, risk assessments, work plans, compliance programs, monitoring, auditing & oversight programs for health plans and delegated entities; lead and resolution on FWA incidents; and training on FWA, HIPAA and compliance.
Deb joined Paramount Healthcare in May 2013 and oversees the Risk Adjustment, Coordination of Benefits, and Subrogation departments. Prior to her position with Paramount she had 21 years’ experience working with the State of Ohio workers’ compensation program, both for the government and a contracted managed care organizations. She came to Paramount with extensive knowledge in medical coding, provider billing and education, Medicare payment methodologies, quality assurance, and regulatory compliance. Deb attended The University of Toledo for both her undergraduate and graduate degrees and currently holds a Masters of Business Administration with major in Healthcare Systems Management. She is an active member of the American Health Information Management Association (AHIMA) and is a Registered Health Information Administrator (RHIA) and Certified Coding Specialist, physician based (CCS-P). Deb is also an active member of the America Academy of Professional Coders (AAPC) and is a Certified Risk Adjustment Coder (CRC). Also, Deb is a member of RISE and holds certificates as a Risk Adjustment Practitioner (RAP) and Advanced HCC Auditor (AHCCA). Additionally, Deb is a Board Member of the University of Toledo Health Information Administration Advisory Board, Health and Human Services Alumni Affiliate at The University of Toledo, and Health Information Technology Advisory Committee at Owens Community College.
Jennifer Del Villar Director of Medicare Compliance
Regence
Director of Government Programs Compliance / Medicare Compliance Officer Cambia Health Solutions (Regence)
Jennifer Del Villar is the Director of Government Programs Compliance and the Medicare Compliance Officer for Cambia Health Solutions (Regence BlueCross/BlueShield). Jennifer joined Cambia in October of 2012. Jennifer has been involved in the Health Insurance industry with a primary focus on Medicare Advantage Prescription Drug since 2006.
She and her team are responsible for the overall Medicare Care Advantage Prescription Drug Compliance Program as well as Medicare Supplement and the Federal Employee Program. The team is tasked with auditing, monitoring, reporting, remediation, detection, training, FDR oversight, material reviews, oversight of external and regulatory audits and other tasks relating to the seven elements of compliance. Jennifer states her motto is Compliance is Everyone’s responsibility, never forgetting, everything we do touches a member.
Jennifer holds a Certification in Health Compliance through the Health Care Compliance Association and a Professional, Academy for Healthcare Management designation from AHIP.
Laurie serves as the Vice President of Appeals & Grievances at Beacon Healthcare Systems. With more than 20 years of experience overseeing Medicare appeals and grievances for two of the nation’s largest and most highly respected health plans, she currently provides oversight of the company’s highly acclaimed Beacon’s Appeals Manager (BAM), the industry’s most intuitive and easy-to-use appeal and grievance tool.
Mark Dwinnells, CHC, has over a decade of experience in the operation of Part C, Part D, Medicaid, and other health insurance plans. He is one of two Compliance Managers for Health Plan Compliance at Commonwealth Care Alliance, Inc., with over 5 years compliance experience in CCA's dual eligible plans. Mark in the Health Plan Compliance role has overseen CCA through its expansion from Massachusetts to include Rhode Island, California, Michigan, and soon to be launch in Indiana, with lines of business including MAPD, D-SNP, FIDESNP, and an MMP plan. He has expertise in oversight of FDRs and Medicaid Material Subcontractors, while also building out systems, processes, and documentation to carry out effective Medicare and Medicaid Compliance activities.
An Independent Consultant with over 20 years’ health plan experience optimizing operations, improving clinical programs, and developing highly effective teams. She has extensive Medicare knowledge and experience working with both State and Medicare regulators to resolve complex issues and advocate for change.
She most recently left Cambia Health Solutions (Regence Blue Cross Blue Shield) where she led her teams through successful ODAG, CDAG, NCQA, and other audits related to coverage decisions, appeals, and grievances. Over 10-year track record of achieving and maintaining 4+ star ratings on the Part C appeals and Complaint Tracking Module (CTM) measures.
Throughout her 20.5-year tenure at Cambia, she gained a holistic prospective of the health insurance business, by leading the following departments: Prior authorization, Inpatient Management, Member Appeals & Grievances, Provider Appeals & Disputes, Medicare Membership, Payment Integrity, Clinical & Clinical Review & Reimbursement, Policy and Reimbursement, Quality of Care, Clinical Programs & Strategic Partnerships, Project Implementation, and Strategy & Execution. She is currently helping health plans improve performance and increase star ratings.
Cristina Garcia is a seasoned professional with extensive experience in public and non-profit organizations. As the Director of the Participant Services Center at the Motion Picture Industry Pension and Health Plans (MPI), she plays a crucial role in the smooth operation of the Call Center. With over a decade of expertise in Medicare and Medicaid Cristina is dedicated to assisting participants with their MPI benefits. Her deep understanding of the healthcare system allows her to provide valuable guidance and support to individuals navigating their Medicare plans. Cristina's academic journey began at Rutgers University, where she earned both a bachelor's and master's degree. Her strong educational background has laid a solid foundation for her work and contributed to her success in the field. Her commitment to continuous learning is evident through her attainment of a MAGIC Certification, which emphasizes hands-on, simulation-based, experiential learning. Cristina values empathy, respect, caring, and accountability as the core of her personal and professional approach, transforming interactions from transactional to relational. Prior to joining MPI, Cristina focused on developing and implementing community education programs throughout Los Angeles County. Her passion for empowering individuals and fostering cross-cultural understanding led her to work closely with Spanish-speaking communities in Ecuador, Nicaragua, Guatemala, and El Salvador. Cristina Garcia brings a wealth of knowledge and dedication to her role at MPI, ensuring that participants receive exceptional support and service. Her diverse experiences and commitment to ongoing growth make her a valuable asset to any project or initiative she undertakes.
Linda Gates-Striby has worked in the medical field for over 30 years and has specialized in cardiology coding and revenue cycle for 25 years. Her clinical experience includes work in the heart stations and coronary intensive care units as well as working as an EMT for a level one trauma center.
As a MedAxiom Revenue Cycle Solutions consultant, Linda provides cardiovascular programs across the country with operational expertise, implementation strategies and simplification for often complex initiatives to minimize risk and maximize revenue. Linda, who has spent the past 30 years working as a specialist in compliance, revenue cycle and quality with a large cardiology and multi-specialty practice, is also the director of quality assurance with Ascension Medical Group in Indiana.
Linda is a sought-after speaker and consultant and has conducted numerous national educational sessions focused on documentation, coding, auditing and revenue cycle improvement for clinicians, coders and administrators across the nation.
Linda serves as a non-physician member of the American College of Cardiology’s coding work group and publications subcommittee and has also served on the coding committee for the Heart Rhythm Society. Linda served as the cardiology chair on the Board of Advanced Medical Coding and lead the development of the Advanced Cardiology and Specialty Cardiology Certification examinations, as well as the technical editor for cardiology focused newsletters. Linda has served as an Independent Review Organization auditor for Office of Inspector General Corporate Integrity Agreements, and as an expert witness on behalf of cardiology practice.
Karen Mason, MBA, is Director, Client Services at BluePeak Advisors, a division of Gallagher Benefits Services, Inc. Karen has been in the health care industry for over 20 years with experience in Medicare, Medicaid, Individual and Employer plans. Karen has extensive experience in CMS and other government requirements, specifically related to Contact Center and Appeals and Grievances. Within those areas, she has implemented new plans, assisted plans in turnaround efforts, and functioned as an operational leader.
At BluePeak, Karen is responsible for partnering with clients to find solutions to meet their key objectives and goals. Her firsthand experience leading health plan operations coupled with her knowledge in plan implementations, project management and process improvement allow Karen the ability to support a client from different angles to develop strong solutions and drive results.
Prior to BluePeak Advisors, Karen worked as a director supporting various clients with building new government health plans. Karen’s primary focus was implementing infrastructure and ensuring regulatory compliance for the plan Contact Center and Appeals and Grievances departments. In this role Karen also served as a consultant to existing plans who were not within regulatory requirements and assisted with remediation and the successful passing of validation audits.
As a Senior Director Karen took over running TPA operations of Appeals and Grievances and Contact Center for numerous health plans, overseeing over 400 employees who supported over 1 million plan members. Karen demonstrated a successful model of meeting or exceeding operational metrics, driving process improvements and staying on top of changing regulations. Karen successfully led her departments through numerous government audits and supported NCQA accreditation for the organization.
Karen has worked as a Black Belt Six Sigma Project Specialist, driving process improvement in various parts of the health plan space including Utilization Management, Population Health and Case Management. Starting out as a Customer Service Representative within the Behavioral Health plan space, Karen keeps the member at heart as she navigates the complexities of health plan infrastructure and regulations, with a personal mission to make access to care simpler for people who need it.
JoAnn McDaniel-Chinn in 2023 transitioned to become the Compliance Director and Privacy Officer for Wellcove powered by CHCS Services, inc an Third-Party Administrator. Simply Healthcare in Miami, Florida Medicaid Compliance Officer for 3 ½ years. She oversaw the Compliance team and the Special Investigation Unit (SIU). Before her current role, she held the Compliance Officer role for Community Care Plan and led the Privacy, Compliance, and SIU. Before making her way to the Sunshine State, 4 ½ years ago, she worked at Gateway Health Plan in Pittsburgh, PA, for 7 ½ years in various roles. She holds a bachelor’s degree and master’s degree from Point Park University in Criminal Justice Administration. She is a member of the American College of Healthcare Executives and the Health Care Compliance Association. In her free time, she spends her time volunteering for local foster care agencies and mentoring young women through various organizations/board appointments.
Crescent Moore, PharmD, PhD is a Pharmacist and Senior Health Plan Services Consultant and the Part D lead at BluePeak Advisors, a division of Gallagher Benefit Services, Inc. With 10 years of health policy and Medicare experience, Crescent lends her expertise in Part D operations, specifically coverage determinations, appeals, and grievances (CDAG), medication therapy management (MTM), overutilization management system (OMS)/drug management program (DMP), and formulary administration (FA) as well as Part D Stars strategy to clients.
Prior to joining BluePeak Advisors, Crescent worked as a director of clinical pharmacy at a managed care company where she was responsible for the strategic direction of the clinical pharmacy programs and initiatives for all lines of business. In her role, she successfully completed Medicare audits (program, timeliness, transition, and desk audits) as well as the transition of Medicare Part D coverage determinations and appeals from the pharmacy benefit manager to the health plan.
Crescent earned a Doctor of Philosophy degree and a Doctor of Pharmacy degree from the University of Tennessee and completed a health policy and association management residency at the Tennessee Pharmacists Association. She received a Bachelor of Science degree in Chemistry from Rhodes College.
Melissa Rusk CLSSBB, CPC is the Vice President of Operations at SummaCare in Akron Ohio. In this role, Melissa is responsible for directing and providing leadership to SummaCare’s operational departments including Claims Processing and Support, BPO Operations, Document Management, Configuration, Eligibility & Billing, and Fraud, Waste and Abuse for both SummaCare and Apex Health Solutions. She ensures production and performance measures are achieved while adhering to applicable state and federal regulatory requirements as well as maintains relationships with employers and regulatory agencies and serves on the Senior Management team.
Melissa has over 30 years’ experience working within the insurance industry in customer service, compliance and operations.
She is a Lean Six Sigma Black Belt and is certified in Lean by the University of Akron and earned her CPC designation in November 2020.
Annie Hsu Shieh is Sr. Director of Compliance, CA ComplianceOfficer at Bright Health, where she specializes in health care laws,reimbursement, compliance, fraud & abuse, privacy, antitrust, andcontractual issues.
Annie develops corporate-wide policies andprocedures, administers HIPAA/HITECH privacy and compliancetraining, conducts internal audits, investigates complaints, andinterprets CMS, HHS, OIG, managed care, and Medicare regulationsand guidance. Annie has received numerous publication credits, including “LegalIssues Concerning Retail Clinics,” a Reproductive Health Guideto the Medicaid Program, and a tutorial on Medicare AdvantageCompliance Program Guidelines. Annie is a Citation Editor for theJournal of Health & Life Sciences Law. Annie spoke at the 2011American Health Lawyers Association Annual Meeting on ethicsand served as the Social Media Workforce Chair of the YoungProfessionals Council from 2010-2013.Annie’s experience began with Lehman Brothers’ WashingtonEquity Research Group. There, she wrote weekly articles toinstitutional investors about expected changes in Medicarereimbursement and how they financially impacted the health careindustry.
In law school, she worked as the first Diversity Internfor the American Health Lawyers Association; Law Clerk for theDepartment of Managed Health Care; Summer Associate at aproducts liability law firm where she worked on the Merck Vioxxsettlement; and Post-Bar Fellow at the National Health Law Program.Annie obtained her B.A. in Public Health from Johns HopkinsUniversity and her J.D. from Loyola Law School, where shecompleted the Health Care Law track and was President of theHealth Law & Bioethics Association. In 2014, Annie was namedthe Alumni Honoree by the Loyola Law School Health Law & Bioethics Association for her contributions to establishing a healthlaw externship for law students and post-bar fellows.
Beth is the Medicare Compliance Director at Longevity Health Plan. She has been working in the Medicare Advantage space for almost two decades specializing in Compliance, Quality, and Case Management.
Beth started her career as an oncology social worker, and later helped build and develop Care and Disease Management programs to support the most vulnerable members of our communities. Beth is also the coauthor of an Amazon best-seller – Living Kindly: Bold Conversations about the Power of Kindness.
