Jemirah Holland
Tallahassee,FL
Summary
Strategic and results-driven compliance professional with 15 years of experience in regulatory compliance, contract management, and Medicaid program oversight. Subject matter expert (SME) in federal and state healthcare regulations, with demonstrated success in driving corrective actions, managing audits, and implementing enterprise-wide compliance strategies. Proven ability to collaborate cross-functionally, lead risk assessments, and strengthen organizational compliance culture. Skilled in leading cross-functional teams to implement corrective action plans, developing policies, and coordinating HIPAA compliance programs.
Overview
11
11
years of professional experience
Work History
Health Insurance Specialist
Centers for Medicare and Medicaid Services (CMS), Division of Managed Care Operations
04.2023 - Current
- Serve as a subject matter expert (SME) on Medicaid regulatory and contractual requirements for assigned states.
- Provide technical guidance to Medicaid state agencies and CMS teams, ensuring compliance with federal mandates.
- Maintain a repository of nearly 800 regulatory requirements and conducts reviews of Medicaid managed care contracts.
- Lead cross-functional projects focused on improving standard operating procedures (SOPs), workflows, and program delivery.
- Coordinate and monitor corrective action plans (CAPs) and compliance reporting deliverables.
- Review member-facing materials and provider communications for HIPAA and regulatory compliance for over 10 Medicaid managed care plans.
Senior Project Manager, Clinical Studies
Health Services Advisory Group, Inc.
10.2022 - 03.2023
- Directed Medicaid audit activities, contract evaluations, and quality-of-care reviews for state Medicaid agencies.
- Managed cross-functional teams to support timely and accurate submission of audit responses and implementation of corrective actions.
- Led development of dashboards, tracking summaries, and regulatory reporting tools to inform leadership and state Medicaid agencies.
- Trained internal teams on compliance protocols and regulatory policies.
- Reviewed member-facing materials and provider communications for HIPAA and regulatory compliance for three states including over fifteen Medicaid managed care plans.
- Ensured compliance with CMS requirements through documentation review, formal audits, and stakeholder engagement.
Program Administrator
Agency for Health Care Administration (AHCA), Bureau of Medicaid Quality
08.2020 - 10.2022
- Led a team of contract managers and oversaw all Florida Medicaid research and evaluation contract activities.
- Managed a $17M Medicaid contract portfolio including external quality reviews and waiver evaluations.
Government Analyst II
Agency for Health Care Administration (AHCA), Bureau of Medicaid Quality
02.2017 - 08.2020
- Managed planning and readiness reviews for Medicaid managed care plans; conducted desk audits for regulatory compliance.
- Responded to CMS and state audits, including the development, tracking, and implementation of corrective action plans (CAPs).
- Drafted Medicaid managed care contracts, ensuring compliance with state and federal law.
- Developed policy guidance for performance improvement projects (PIPs).
- Coordinated quarterly Medicaid managed care plan performance meetings, made recommendations for compliance improvements, and contributed to Board-level compliance reporting.
Medical Health Care Program Analyst I
Agency for Health Care Administration (AHCA), Bureau of Medicaid Program Integrity
08.2016 - 02.2017
- Investigated provider fraud and conducted data analysis using Florida Medicaid Management Information System (FMMIS), Decision Support System (DSS), and Statistical Analysis Software (SAS).
- Investigated provider fraud and conducted data analysis using FMMIS, DSS, and SAS.
- Authored reports and recommended corrective actions and formal audits.
- Monitored compliance with fraud prevention and Medicaid integrity standards.
Social Services Director
Tallahassee Developmental Center
04.2014 - 08.2016
- Managed Medicaid eligibility and compliance for ICF/IID residents.
- Led compliance audits and participated in HIPAA training programs.
- Developed staff training modules on abuse prevention, resident rights, HIPAA and regulatory compliance.
Education
Bachelor of Social Work -
Florida State University
Master of Social Work - undefined
Florida State University
Skills
- Medicaid managed care
- Policy analysis
- HIPAA compliance
- Stakeholder engagement
Timeline
Health Insurance Specialist
Centers for Medicare and Medicaid Services (CMS), Division of Managed Care Operations
04.2023 - Current
Senior Project Manager, Clinical Studies
Health Services Advisory Group, Inc.
10.2022 - 03.2023
Program Administrator
Agency for Health Care Administration (AHCA), Bureau of Medicaid Quality
08.2020 - 10.2022
Government Analyst II
Agency for Health Care Administration (AHCA), Bureau of Medicaid Quality
02.2017 - 08.2020
Medical Health Care Program Analyst I
Agency for Health Care Administration (AHCA), Bureau of Medicaid Program Integrity
08.2016 - 02.2017
Social Services Director
Tallahassee Developmental Center
04.2014 - 08.2016
Master of Social Work - undefined
Florida State University
Bachelor of Social Work -
Florida State University
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