Allison Alvarez Sheffer
Prospect,KY
Summary
Accomplished compliance leader with extensive experience in Medicare Advantage Plan compliance, risk management & mitigation, and regulatory oversight seeking to leverage proven expertise to build relationships and provide meaningful resolutions to minimize risk exposure to IFG and all its stakeholders.
Overview
24
24
years of professional experience
Work History
Senior Compliance Professional
Humana
10.2024 - Current
- Provides oversight of top-risk external agencies, including IFG and its downlines, ensuring adherence to Humana and CMS compliance thresholds and mitigating identified risks.
- Develops and authors policies and procedures to ensure ongoing compliance with federal (CMS) and state Medicaid guidelines, while actively monitoring regulatory updates and coordinating the implementation of new requirements to external partners.
- Manages a monthly and annual audit work plan for delegated entities, overseeing completion of scheduled audits and supporting audit readiness.
- Monitors monthly call quality for high-risk partners, analyzing agent interactions and identifying noncompliance trends for corrective actions.
- Conducts root cause analysis and identifies compliance trends to provide partners with guidance and support.
- Prepares and presents key performance metrics, audit findings, and regulatory updates to senior leadership.
- Facilitates training sessions and provides compliance guidance to internal teams and external partners.
- Collaborated with cross-functional teams on various ad hoc projects, including CTM Mitigation and AI investigation.
Senior Risk Management Professional
Humana
05.2023 - 10.2024
- Directed a team of ten associates in triaging and resolving cases to meet Medicare and Medicaid mandated timelines.
- Served as a subject matter expert in the investigation of complex and high-priority cases (executive, DOI, privacy, etc.) often in collaboration with Legal, Ethics, and SIU teams to make allegation determinations and assign effective corrective action.
- Developed and pioneered the Failure to Respond protocol, improving documentation compliance and risk mitigation for delegated entities.
- Aligned offshore associates with training, investigations, and audits to ensure regulatory requirements were met.
- Participated in review boards to issue corrective actions and support agent suspensions/terminations based on compliance findings.
Compliance Professional
Humana
09.2021 - 05.2023
- Investigated allegations of noncompliance in the sale and marketing of Medicare Advantage plans to prospective members in accordance with government rules and regulations.
- Provided subject matter expertise in investigative procedures and case analysis to both peers onshore and offshore.
- Researched compliance issues and developed policies and procedures of various complexity to ensure compliance with Medicare and Medicaid contracts when deficiencies were identified.
District 1 School Board Rep
Oldham County Board of Education
03.2023 - Current
- Elected official responsible for regulatory compliance and policy development, managing a $240M annual budget.
- Authored, reviewed, and approved district-wide policies and procedures, ensuring alignment with state regulations.
- Developed strategic growth plans and implemented cost controls for operational efficiency.
Chief of Operations
Green Apple Restaurant Group
01.2003 - 04.2019
- Designed and developed the corporate strategy leading to the creation of 5 restaurants with over $7M in sales and a staff of 100.
- Managed construction projects for new restaurant openings, overseeing timelines and budgets.
- Sourced products and developed supply chain and inventory management to assess quality, timeliness, and compliance of vendors while maintaining strong customer service and relationship.
- Ensured corporate compliance with all federal and state laws and regulations applicable to the food services industry to mitigate risk and uphold ethical standards.
- Ensured retention of staff by creating human resource guidelines and training procedures.
Education
MBA - Public Health
University of Alabama at Birmingham
Advanced Degree - Gerontology
Bellarmine University
BBA - Marketing & Accounting
Belmont University
Accomplishments
- 4 Year Division 1 Athlete
- US Citizen Secret Security Clearance
- Humana Star Award
- 2 Humana Green Glove Recognitions
Timeline
Senior Compliance Professional
Humana
10.2024 - Current
Senior Risk Management Professional
Humana
05.2023 - 10.2024
District 1 School Board Rep
Oldham County Board of Education
03.2023 - Current
Compliance Professional
Humana
09.2021 - 05.2023
Chief of Operations
Green Apple Restaurant Group
01.2003 - 04.2019
MBA - Public Health
University of Alabama at Birmingham
Advanced Degree - Gerontology
Bellarmine University
BBA - Marketing & Accounting
Belmont University