Deanna Lamonte
Michelle
Louisville,KY
Summary
To utilize my Medicare and Medicaid regulatory knowledge and operational experience to minimize risk to the Enterprise
Overview
30
30
years of professional experience
Work History
Team Lead/Arbitrator/Stakeholder Engagement
Provider Resources, Inc.
02.2023 - Current
- Audit team performance with No Surprises Act federal Independent Dispute Review Entity (IDRE) disputes ensuring compliance with CMS requirements.
- Improved team productivity by implementing efficient project management strategies and streamlining communication channels.
- Cultivate positive relationships with internal and external partners.
- Develop and maintain effective relationships with key stakeholders to better understand their needs and expectations.
- Lead cross-functional teams for successful project execution while maintaining strong collaboration among team members.
- Generate reports detailing findings and recommendations.
- Collaborate with other department leads to streamline workflows, improve interdepartmental coordination, and achieve business goals collectively.
Medicare and Medicaid Senior Product Compliance Professional
Humana
03.2013 - 03.2023
- Lead Product Compliance team through the process of developing Medicare marketing materials (Annual Notice of change, Evidence of coverage, Summary of benefits), delivery of those materials to members per CMS Marketing guidelines and review for compliance marketing and communication materials including filing with CMS.
- Served as a Humana Medicare Advantage Part C and Part D and MMP marketing material subject matter expert
- Review, approve, and file Humana Medicare and MMP marketing material in the CMS HPMS system ensuring regulatory and contract compliance
- Designated Humana Medicare-Medicare Plan (MMP) Marketing Material Product Compliance point of contact for CMS, the State of Illinois, and South Carolina
- Draft and continually update Product Compliance policies and procedures
- Review CMS and state issued guidance to identify impacts to product compliance work and update Humana’s Enterprise Solution Point system.
Medicare Claims Payment Policy Consultant
Humana
03.2010 - 03.2013
- Serve as Medicare and Medicare Advantage Part C and Part D subject matter expert for claims payment and reimbursement policies
- Research, analyze, and interpret Medicare/Medicare Advantage regulations, manuals, and directives to recommend and ensure compliance
- Acted as liaison between Humana’s Medicare Claims Policy team and Regulatory Compliance as well as other departments across the company
- Provide strategic leadership and consultation services for Humana’s Medicare Claims Payment Policy Team and Provider Network Operations (PNO) area
- Research, prepare, develop and present Medicare policy recommendations while interacting and building partnerships with other functional areas within Humana
- Triage assignments based on urgency and ensure escalation when necessary.
Medicare Risk Advisor
Humana
03.2008 - 03.2010
- Monitor and analyze new and updated regulatory guidance to determine impacts to functional areas of Humana government programs (Medicare Part C, Part D, and Medicaid)
- Research and offer consultation and advice to all areas throughout the company to ensure compliance with regulations impacting government programs
- Maintain knowledge base and understanding of regulatory requirements impacting Humana government programs
- Utilize a comprehensive understanding of Original Medicare, Humana business, and industry trends to recommend compliant and efficient solutions.
Medicare Claims Policy Consultant
Humana
03.2007 - 03.2008
- Analyze Original Medicare claims reimbursement policies and determine impacts to Medicare Advantage Part C business
- Recommend compliant and efficient application of Original Medicare claims reimbursement policies to Humana’s Medicare Advantage Part C and Part D business
- Propose Humana Medicare Claims payment and reimbursement policies and present proposals to various company-wide leaders for review and approval
- Develop and implement the initial Humana Claims Policy template.
Medicare Legislative and Regulatory Implementation Department (LRID) Advisor
Humana
03.2005 - 03.2007
- Project deliverables that show compliance with CMS intent for Part C and Part D
- Implementation Advisor for Medicare Advantage Part C and Part D including Humana’s initial Part D implementation
- Develop detailed implementation project plans consistent with regulatory requirements in accordance with Humana policies and procedures
- Provide feedback through planning meetings and questionnaires, and facilitate optimal solutions in a wide variety of regulatory situations.
Medicare Policy Consultant/Technical Writer
Humana
03.2000 - 03.2005
- Consult with various departments company-wide as it relates to Medicare Advantage Part C operational policies, processes and procedures and the impact to educational and procedural needs
- Analyze Humana Medicare policies, processes and procedural changes and make decisions on behalf of the NEPD Policy team
- Publish new Humana Medicare Advantage Part C policies, processes and procedures and update Humana’s central documentation repository.
Medicare Operations Supervisor
Humana
09.1994 - 03.2000
- Direct and control the work activities of Medicare Advantage Part C and Part D customer service unit
- Select, train, motivate and develop employees to ensure maximum performance
- Provide technical leadership to operational team and train new-hires.
Education
Bachelor of Science - Occupational Training and Development
01.2005 -
Skills
Organizational Skills
undefinedTimeline
Team Lead/Arbitrator/Stakeholder Engagement - Provider Resources, Inc.
02.2023 - Current
Medicare and Medicaid Senior Product Compliance Professional - Humana
03.2013 - 03.2023
Medicare Claims Payment Policy Consultant - Humana
03.2010 - 03.2013
Medicare Risk Advisor - Humana
03.2008 - 03.2010
Medicare Claims Policy Consultant - Humana
03.2007 - 03.2008
Medicare Legislative and Regulatory Implementation Department (LRID) Advisor - Humana
03.2005 - 03.2007
University of Louisville - Bachelor of Science, Occupational Training and Development
01.2005 -
Medicare Policy Consultant/Technical Writer - Humana
03.2000 - 03.2005
Medicare Operations Supervisor - Humana
09.1994 - 03.2000
Similar Profiles
Tami RoccoTami Rocco
Stakeholder Engagement CSR at Provider Resources IncStakeholder Engagement CSR at Provider Resources Inc
Sabine PircherSabine Pircher
Arbitration Specialist and Quality Assurance Subject Matter Expert at Provider Resources Inc.Arbitration Specialist and Quality Assurance Subject Matter Expert at Provider Resources Inc.
Keiessence ReedKeiessence Reed
Provider Enrollment Assistant at Medical Provider ResourcesProvider Enrollment Assistant at Medical Provider Resources
Maria GomezMaria Gomez
Lead Care Manager at Pair TeamLead Care Manager at Pair Team
Evelyn RobertsEvelyn Roberts
Human Resources at Driftboat ManagementHuman Resources at Driftboat Management