Kyle Creager
Scottsdale,AZ
Summary
Driven and collaborative healthcare compliance executive with 12+ years professional experience managing corporate compliance and ethics programs with ACOs, health plans, and PBMs across multiple lines of business. Outstanding record of relationship-building with federal/state regulators, payers/providers and key business stakeholders to promote a culture of compliance. Effective communicator and leader with a strong history of mentoring compliance staff to achieve both career and strategic business goals.
Overview
12
12
years of professional experience
Work History
Chief Compliance & Governance Officer
Intrinsia Health
09.2022 - 10.2023
- Chaired ACO REACH Compliance, Governing Board and Policy Review Committees
- Served as ACO Privacy Officer
- Served as Co-Lead in development of ACO REACH Health Equity Plan
- Developed full suite of policies & procedures and ACO Standards of Conduct
- Developed and implemented Cooperative Learning Provider Education Series
- Created and owned ACO Compliance Plan and Annual Risk Assessment
- Managed relationship with CMS/CMMI Administration and Regional Office
Chief Compliance Officer
Apricus Health
03.2022 - 08.2022
- Led Direct Contract Entity (DCE) Compliance Program within CMS’ GPDC Model
- Provided regular compliance reporting to DCE Board of Directors
- Served as DCE Privacy Officer
- Managed DCE Compliance and Credentialing staff
- Served as executive liaison to Center for Medicare and Medicaid Innovation (CMMI)
- Developed and implemented effective compliance education/training for network providers and enterprise staff
Compliance Lead
Bright Health Group
09.2020 - 02.2022
- Chaired quarterly enterprise Compliance Committee meetings
- Coordinated plan response to external state and federal regulators for compliance CPE Audit and Market Conduct Exams
- Owned policy and procedure management function for Bright Health Group
- Disseminated new regulatory guidance to enterprise for Commercial and Medicare markets
- Managed Sales Compliance oversight function for Bright HealthCare
- Managed SIU function including intake, investigation and response to FWA cases
Compliance Manager
Cigna Healthcare
11.2019 - 09.2020
- Managed CLIA licensure application and renewal function including investigation of regulations for new or expanding business
- Ensured compliance with State and Federal laws and regulations for new, existing, and expanding lines of business
- Managed medical records compliance/processing and fulfillment requests
- Managed Health Information Management (HIM) Release of Information in EPIC
- Conducted and managed regulatory and licensing audits for Cigna Onsite Health
Senior Compliance Auditor
Solera Health
11.2018 - 11.2019
- Developed and managed provider FDR desktop and on-site audits
- Completed Annual Risk Assessment for Compliance and Information Security functions
- Managed provider risk assessment/scoring tool
- Facilitated provider audit meetings and CAP remediation process
- Responded to, managed, and tracked all incoming Health Plan Audit requests
Senior Compliance Auditor
EnvisionRx Options, a RiteAid Company
12.2016 - 11.2018
- Conducted compliance monitoring and auditing of key operational areas and FDR’s
- Assessed and identified vendors as possible FDR or URAC delegated entities
- Managed health plan’s Agent/Broker Oversight Program
- Responded to and investigated all reported instances of non-compliance received via Compliance Hotline, CTM and Grievance database
- Managed HPMS memo communication process and coordinated enterprise response
Senior Consultant - Medicare STARS Quality & Compliance
CVS Health
11.2014 - 10.2015
- Facilitated development and implementation of star rating improvement initiatives
- Created and maintained Stars Client Reporting Database
- Conducted analysis and created projections for client plan rating performance
- Presented findings and recommendations to executive-level stakeholders, effectively communicating key insights and action plans
Consultant, Medicare Sales Compliance
Cigna Healthcare
05.2013 - 11.2014
- Evaluated broker and sales agent compliance performance against business objectives
- Delivered outstanding service to clients to maintain and extend relationship for future business opportunities
- Liaised with customers, management, and sales team to better understand customer needs and recommend appropriate solutions
- Collaborated with cross-functional teams to successfully deliver comprehensive training solutions for clients
Analyst/Trainer - Medicare Operations & Compliance
CVS Health
08.2011 - 05.2013
- Tracked and ensured compliance of corporate and federally mandated CMS training for Beneficiary Communications team
- Supported internal/external regulatory audits, reviews and site visits
- Identified clear connections between policies and business results to eliminate or reduce confusion and help employees achieve goals
- Improved internal knowledge sharing by developing comprehensive documentation outlining standard operating procedures for various tasks
Education
Bachelor of Arts - English Literature
Arizona State University
Tempe, AZ12.2008
Skills
- Microsoft Office (Word, Excel, PowerPoint, OneNote, Visio, Access, Teams, OneDrive, Outlook)
- Skype
- Zoom
- Acumen (CMS)
- HPMS
- Salesforce
- IDEA
- Bilingual (Spanish)
- SharePoint
- Snag-It Editor
- Tableau
- LogicManager
- ShareFile
- Slack
- Compliance360
- CMS 4i System
Timeline
Chief Compliance & Governance Officer
Intrinsia Health
09.2022 - 10.2023
Chief Compliance Officer
Apricus Health
03.2022 - 08.2022
Compliance Lead
Bright Health Group
09.2020 - 02.2022
Compliance Manager
Cigna Healthcare
11.2019 - 09.2020
Senior Compliance Auditor
Solera Health
11.2018 - 11.2019
Senior Compliance Auditor
EnvisionRx Options, a RiteAid Company
12.2016 - 11.2018
Senior Consultant - Medicare STARS Quality & Compliance
CVS Health
11.2014 - 10.2015
Consultant, Medicare Sales Compliance
Cigna Healthcare
05.2013 - 11.2014
Analyst/Trainer - Medicare Operations & Compliance
CVS Health
08.2011 - 05.2013
Bachelor of Arts - English Literature
Arizona State University
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