How Health Plans Can Optimize Compliance Oversight of Member Services

Health Partners Plans shares insights on:

  • Compliance strategies to minimize CTMs to avoid hits to your Star Rating
  • Best practices for auditing and monitoring your call centers
  • Why it’s crucial to ensure you have robust language and translation services
  • How to turn your member services and call center into an asset rather than a compliance liability
Originally recorded on February 12th, 2020

Meet the Speakers

Michelle Fogg
Manager of Operational Compliance
Health Partners Plans

Michelle Fogg serves as Manager of Operational Compliance for Health Partners Plans. In this role, she is responsible for leading and overseeing the internal and external monitoring processes under the Medicare line of business; ensuring compliance with state and federal laws and regulations. Her direct oversight spans from Pharmacy, Transition Letters, Member Relations, Enrollment, Sales (internal and external), Organization Determination, Coverage Determinations, Appeals (C & D), Grievances (C & D), Claims, LEP, LIS, Network Management, and SNP MOC. She is also responsible for creating and implementing Health Partners Plans’ FDR Program.

Michelle has over 17 years’ experience working within the insurance industry, with 13 years working directly under the Medicare umbrella in local Philadelphia plans as well as national plans. Michelle’s initial introduction to insurance started out in the call center where she developed a strong sense of wanting to educate the members on their health benefits. It was not until she began working with the Medicare business that she truly fell in love with compliance. This resolve stuck with her through her many positions that she has held under Medicare that includes creating a platform in a national organization to review the impact of complaints, process improvement efforts, and conducting monitoring efforts to ensure operational compliance to proactively foresee negative impacts to name a few.

Angela Lloyd
Director, Medicare Audit & Corrective Action
Health Partners Plans

Angela Lloyd, MPH is the director of Medicare audit and corrective action at Health Partners Plans of Philadelphia (HPP). Angela is responsible for the oversight of Medicare audit program, which includes operations and processes, analyzing data, reviewing Policies and Procedures, documenting work and drafting audit reports. She also works collaboratively with leadership of operational units, and partners with vendors to ensure corrective action plans are developed and manages them through implementation.

Angela has worked at HPP for 13 years and has over twenty years of product, compliance and operations experience in Medicaid and Medicare programs. Angela’s creative and result focused program has proven successful in driving compliance throughout the organization. Her expertise in the execution of regulatory contractual requirements with the understanding of policy in various channels has improved the companies understanding and awareness of the products offered under the Centers of Medicare and Medicaid Services especially the Special Needs product. Angela truly strives for excellence in everything she does keeping the HPP communities and membership in mind. Angela received a bachelor’s degree in business law, graduate degree in public health from Drexel University and is Certified in HealthCare Compliance.

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