2022 Speakers

IU Health, Inc.

Tammy Chadd, CHC, CHPC

Compliance Program Manager
BlueCross BlueShield of North Carolina

Nicole Henderson, MBA, CSM

Director, Stakeholder Escalations
MMM Holdings LLC

Michael Soto Maldonado, MHCM

A&G Manager, Medicare Advantage & Medicaid
SummaCare

Deborah Marine, JD, CHC

Chief Compliance Officer,Health Plan Operations
UPMC Health Plan

Rebecca Richards

Senior Manager, Medicare/SNP Complaints and Grievances
CHRISTUS Health Plan

Krishelle Watts, MHA

Manager of Regulatory Compliance
Cody Consulting Group

Hannah LaMere, MA

Sr. Director, Consulting
Cody Consulting Group

Michelle Larson, CHC

Sr. Consultant, Compliance Solutions
Health Plan of San Mateo

Karla Rosado-Torres

Medicare Product Manager
Virtusa

Alok Mandal

Vice President - Technology
Inovaare

Gabe Viola

Senior Vice President, Customer Relations and Implementations
Inovaare

Craig Giangregorio

Senior Vice President, Healthcare Solutions
SummaCare

Tracy Jones

Senior Compliance Coordinator
Speakers Biographies


Tammy Chadd, CHC, CHPC

Compliance Program Manager
IU Health, Inc.

Tammy Chadd is the Compliance Manager at IU Health Plans; she is certified in Healthcare Compliance (CHC) and Healthcare Privacy Compliance (CHPC). She is an experienced compliance professional who is responsible for FDR oversight, audit readiness, and is the embedded resource for the Grievances and Appeals, Customer Solutions, VMO, and PMO teams. In her spare time at work, she supports the FWA/SIU department. Tammy was previously employed at MDwise as the Compliance Officer and Chief Privacy Officer. She brings over 20 years of compliance experience to Health Plans.

Tammy is driven to be the best version of herself every day and takes pride in supporting compliance team members, internal department staff, and external stakeholders to help the Health Plan continuously improve and to mature the compliance program. She currently resides in Indianapolis, Indiana with her husband, son, and dog, Dempsey; her officemate since working from home. Free time and leisure activities tend to focus on outdoor activities; she and her husband also enjoy home brewing.

Nicole Henderson, MBA, CSM

Director, Stakeholder Escalations
BlueCross BlueShield of North Carolina

Nicole Henderson joined Blue Cross Blue Shield of North Carolina (Blue Cross NC) in 2017 as Director, Stakeholder Escalations with a distinct focus on Regulatory Complaints. In her role, she is responsible for escalation management across multiple teams and implementing compliance strategies that promote a customer-focused culture.

Before joining Blue Cross NC, Nicole served in various roles at Horizon Blue Cross Blue Shield of New Jersey for 15+ years. Nicole has over 20 years of experience in the health insurance industry, which includes 10+ years of experience in the Medicare Advantage line of business related to appeals and grievance management, claims, as well as the Complaints Tracking Module (CTM) complaints. Nicole’s multidisciplinary experience allows her to strategically approach multi-faceted complex situations and solution effectively in the service organization.

Nicole earned a Bachelor of Business Administration from Thomas Edison University as well as a Master’s of Business Administration from the University of Mount Olive. Nicole has also earned the certification of Certified Scrum Master.

Michael Soto Maldonado, MHCM

A&G Manager, Medicare Advantage & Medicaid
MMM Holdings LLC.

Michael has more than 15 years of experience in health care and has worked in the Appeals and Grievances area for 13 years. He started as an AG Coordinator, managing every type of case. After 2 years as an analyst, he was promoted to AG supervisor, and after 3 years, he was promoted to a manager. In 7 years as a manager, he has been involved with several audits including: CMS Performances Audit, Timely Monitoring Project Audit, Data Validation, Medicaid Audit, and some Mock Audits. Michael also has experience leading universe preparation for those audits and presenting cases to CMS auditors.

Deborah Marine, JD, CHC

Chief Compliance Officer, Health Plan Operations
SummaCare

Deborah is the Chief Compliance Officer – Health Plan Operations for the insurance arm of Summa Health System, encompassing SummaCare, Summa Insurance Company, and Apex Health Services. In this role, Deborah is responsible for the health plan compliance program, encompassing all lines of business with an emphasis on Medicare Advantage, Part D, and Marketplace products. The compliance program encompasses Federal and State regulatory compliance, HIPAA Privacy, and Fraud, Waste, and Abuse.

Prior to joining SummaCare, Deborah served for 12 years as the Compliance & Privacy Officer for Health Alliance Plan in Detroit, Michigan. She was in-house counsel, focusing on regulatory compliance, for Univera Healthcare in Buffalo, NY from 1996 to July 2002.

Qualifications and Credentials

Deborah earned a law degree from Case Western Reserve University in Cleveland Ohio in 1995 and is licensed to practice in Ohio (inactive status), New York (retired status), and Michigan (active status). She received her certification in healthcare compliance (CHC) in 2009.

Rebecca Richards

Senior Manager, Medicare/SNP Complaints and Grievances
UPMC Health Plan

Rebecca is a Senior Manager in Appeals and Grievances for a 5-STAR Medicare plan who oversees operational activities with an extraordinary focus on Medicare regulatory guidance and industry best practices. With 8 years of Health Plan experience, her specialized skills include developing internal procedures to ensure compliance, audit readiness, process improvement, policy regulation, and staff development. In June of 2021, Rebecca was a key player in the success of the Appeals and Grievances portion of a CMS Program Audit resulting in the best score the Health Plan has to date.

Rebecca has a Bachelor of Science in Psychology from Slippery Rock University and a Master of Business Administration from West Virginia University. She oversees a team of 2 Supervisors and 21 Coordinators at UPMC Health Plan in Pittsburgh, Pennsylvania.

Krishelle Watts, MHA

Manager of Regulatory Compliance
CHRISTUS Health Plan

As Regulatory Compliance Manager at CHRISTUS Health Plan, I manage and oversee the Medicare Advantage and Prescription Drug (MA-PD) contract to ensure full compliance with all regulatory guidelines mandated by the Center for Medicare and Medicaid Services (CMS).

Through my experience, I have developed skills to improve CHRISTUS Health Plan’s internal auditing and monitoring requirements, risk assessments, and corrective action plans. Examples of my experience include the project management of two CMS Program Audit Revalidations, three Data Validation Audits, and CHRISTUS Health Plan’s most recent One-Third Financial Audit.

I hold a MHA from the University of North Texas Health Science Center in Fort Worth, Texas as well as a Bachelor of Science in Psychology from the University of Oklahoma. I am currently preparing to complete my Certification in Healthcare Compliance (CHC) through the Health Care Compliance Association (HCCA).

In my spare time, I enjoy traveling and spending time with my puppy, Maya.

Hannah LaMere, MA

Sr. Director, Consulting
Cody Consulting Group

Hannah is a skillful leader with 30 years of health plan experience with Medicare and Medicaid. She has held a variety of positions in both operational and compliance roles, including marketing and communications, business process management, Star Ratings performance monitoring and improvement, Part D administration, appeals and grievances, regulatory compliance, and vendor management. In 2016, she successfully led an operational team through the launch of an MAPD plan and was responsible for day-to-day operational compliance of multiple operational areas, vendor oversight for new business process outsourcing model, establishing policies and procedures and controls, developing staffing model, training, process improvement and workforce planning. In her time working at plans she was responsible for plan-wide preparation and readiness and audit playbook execution. She has audited operational functions across all protocol areas, including appeals, grievances, DSNP care coordination, claims, and Part C and Part D coverage decisions.

Michelle Larson, CHC

Sr. Consultant, Compliance Solutions
Cody Consulting Group

Michelle has over 20 years of experience in the healthcare industry with the last 10 years centered on Medicare Compliance. Michelle has expertise in Medicare Advantage and Prescription Drug Plan (MAPD) regulations, compliance, audits, delegation oversight, marketing communications, appeals and grievances, and health plan operations. She currently serves as a Technical Product Manager for the Appeals and Grievances Module with Cody Consulting. Prior to her role with Cody Consulting, Michelle was a Senior Compliance professional at a MAPD plan leading internal and FDR audits to ensure compliance with CMS laws, regulations, contractual agreements, ODAG and CPE requirements. She was also responsible for identifying compliance risks, implementing corrective action plans, CMS audit preparation and readiness, interpretation of regulations, and project managing CMS Annual Reporting, Data Validation, and major regulation changes. Michelle is known for her strong analytical skills, strategic thinking, drive for problem resolution, and is certified in Health Care Compliance from the Health Care Compliance Association.

Karla Rosado-Torres

Medicare Product Manager
Health Plan of San Mateo

Karla Rosado-Torres is the Medicare Product Manager at Health Plan of San Mateo (HPSM). Karla brings 12 years of experience in the healthcare industry, with an expertise in grievances and appeals and Medicare Advantage Plans. She is an experienced leader with demonstrated effectiveness in process improvement and team development. She has been very successful in developing strategies to improve timelines and quality of grievance and appeals processes.

Throughout her career she has worked with several 5-Star Medicare Advantage plans, in which she has standardized and streamlined processes that have helped those organizations accomplish the 5-star rating. She has participated in multiple audits including, accreditation audits (NCQA & AAAHC), CMS Audits and Data Validation Audits, and the State of California Department of Managed Health Care (DMHC) and Department of Health Care Services (DHCS) audits.

As the Grievance and Appeals Manager at HPSM, Karla implemented several processes that led the team to exceed timeliness and quality goals, and complete successful audits. As the Medicare Product Manager, she manages the transition and success of the new D-SNP line of business. Within this role Karla manages the Star Ratings program, CMS Application and Model of Care submission, as well as the CMS Bid process. She is a member/participant of multiple committees, such as the Consumer Advisory Committee and CMC Advisory Committee, Credentialing Review Committee, Provider-Grievance Sub-committee, and the Member Experience Committee.

Alok Mandal

Vice President - Technology
Virtusa

Based in Ellicott City, Maryland, the US, Alok specializes in healthcare- focused enterprise architecture, digital process automation (DPA), data engineering, robotics, artificial intelligence (AI), and cloud-first strategy.

As an executive member of the Healthcare and Life Sciences (HLS) segment, he is responsible for developing and nurturing the Virtusa’s digital strategies and ventures with his expertise on Pega. Alok spearheads our DPA segment and brings incredible vision and business acumen to his role. He helped develop and launch some of the strategic go-to-market strategies including Appeals and GrievancesPega Smart Claims Engine , and Intelligent Automation.

Alok holds a Bachelor of Engineering (BE) in Electrical Engineering from the College of Engineering and Management Kolaghat (CEMK), West Bengal, India, and started his journey with Virtusa in 2019, as a known voice of the Pega community. He is a chief architect with key certifications such as - PegaSystems certified Lead System Architect, TOGAF certified Enterprise Architect, PAHM certified Healthcare Professional, AWS certified Solution Architect, and SAFe certified Agilist.

One of his passionate and innovative contributions to Virtusa is the AI- powered healthcare Pega Solution – Appeals & Grievances (A&G). Virtusa’s A&G is an AI and ML-based solution that provides intuitive and guided workflows to help users navigate through the complex case life cycle. With machine learning at its core for decision making, the solution will enable medical directors to make smarter decisions. Alok is an achiever par excellence and has published a whitepaper and a thought leadership article around the Appeals and Grievances solution.

Gabe Viola

Senior Vice President, Customer Relations and Implementations
Inovaare

Gabriel has over 30 years of experience in the healthcare industry. As an expert in Operations Management, he oversees an array of insurance products and activities, including: Government Programs, Individual, Small Group and Large Group. At Inovaare, Gabriel provides senior-level systems analysis, integration and implementation consulting services. He advises clients in all areas of operational management, regulatory compliance, business process improvement and re-engineering. Prior to joining Inovaare, Gabriel focused mainly in operations and call center management, where he served as the Director of Medicare Operations for Blue Shield of California, leading the Enrollment, Customer Care, Claims, and Appeals and Grievances departments. Gabriel is a results-driven business operations executive with diverse managed care experience. He specializes in guiding health plan operations teams through the highly regulated government programs, with particular expertise in Medicare Advantage and PDP programs.

Craig Giangregorio

Senior Vice President, Healthcare Solutions
Inovaare

A serial entrepreneur and senior leader with 20+ years as an operations, compliance and technology expert, Craig has designed best-in-class practices for health plans. Working alongside the best development team in the industry, he developed, and launched the top CRM and A&G compliance solutions for the payer market.

Tracy Jones

Senior Compliance Coordinator
SummaCare

Tracy Jones is a Senior Compliance Coordinator at SummaCare Health Plan, where she has worked for the past 20 years. Tracy specializes in the development and creation of compliance tools to better assist in the over-sight of the Compliance program. In this role she analyzes the Compliance workflow process from investigations through remediation for quality and appropriateness. Tracy also supports Operational areas such as Contracting, Credentialing and Benefit Configuration. A strong believer in the power of curiosity in the workplace, Tracy campaigns to assist employees with the art of questioning and leadership influence skills.