LISA LEE
15512 Orchid Ave., Tustin,CA
Summary
Dynamic Health Insurance Specialist with a proven track record at UnitedHealth Group, excelling in regulatory compliance and strategic planning. Expert in policy writing and innovative problem solving, I have successfully enhanced operational efficiencies and driven impactful initiatives in healthcare reform, ensuring adherence to insurance regulations while fostering collaborative team environments.
Overview
14
14
years of professional experience
1
1
Certification
Work History
Health Insurance Specialist
Center for Medicare and Medicaid Services, CMMI
Tustin, USA
03.2022 - Current
- Devised programmatic and operational strategies for new Drug Innovation Models(PDSS, M2DL, CGT, VBID) under Medicare Part D and Medicaid .
- Enhanced efficiency of standard procedures for evaluating external communications.
- Verified compliance of health plan documents with required guidelines.
- Evaluate and summarize new CMS and FDA guidance impacting the Division of Drug Innovation.
- Coordinate with multiple governmental entities for new model health plan rollouts.
- Organized panels for experts to review and provide insights on emerging Drug Models.
- Monitored changes in the healthcare industry to ensure compliance with regulations.
- Assisted in developing strategies for cost containment while maintaining high quality standards.
- Conducted comprehensive research and data analysis to support strategic planning and informed decision-making.
Associate Director, Medicare and Retirement, Regulatory Affairs
UnitedHealth Group, UHC
Irvine, USA
12.2021 - 02.2022
- Evaluated compliance of business processes with regulatory requirements and implemented necessary actions.
- Expert in overseeing controlled substances, Part D, Medicaid, and PBM regulations.
- Collaborated with external partners and government entities to draft advocacy documents.
- Craft policy frameworks for UHC M&R concerning anticipated healthcare reforms.
- Communicate regulatory impacts and implications of new legislation to top executives.
- Identified business risks related to regulatory issues and communicated as necessary.
- Managed HR needs for team of Regulatory Affairs Consultants.
- Provided support in the recruitment and training of new staff members.
- Prepared reports and presentations for executive leadership review.
- Maintained compliance with industry regulations and organizational policies.
- Monitored industry trends to recommend actionable strategies.
- Oversaw day-to-day operations of the organization including personnel management, program development and implementation.
Consultant, Regulatory Affairs
United Health Group, Optum
Irvine, USA
11.2016 - 12.2021
- Assessed changes in PBM-related laws due to new guidance.
- Tracked agency guidance, requirements, and notices from CMS, DEA, FDA, FCC, EPA along with State entities.
- Oversaw and tracked regulatory implementation modifications.
- Subject matter expert in Controlled Substances, AWP, PA, Appeals, Grievances, and Clinical formulary requirements.
- Delivered expert regulatory insights across various business areas including ORx clinical products and utilization management.
- Developed resources to streamline access to regulatory updates for account managers.
- Collaborated with external and government affairs to produce advocacy papers.
- Collaborated with clients to develop action plans to address specific challenges and objectives.
- Reviewed existing policies and procedures to suggest necessary improvements.
Health Insurance Specialist
Center for Medicare and Medicaid Services, OHI
Bethesda, USA
07.2015 - 07.2016
- Served as a Federal Hearing Officer during eligibility appeals hearings.
- Created operational policies and procedures for appeals case workers, contractors, and federal hearing officers regarding QHP, Citizenship/immigration, and Medicaid hearings.
- Analyzed congressional inquiries related to FFM appeals.
- Created and organized appeal forms, notices, hearing decision templates for the Marketplace Appeals Group.
- Assessed FHO processes for alignment with regulatory requirements.
- Developed administrative rules and procedures for delegated Medicaid appeals.
Chief of Staff
Office Delegate Aruna Miller
Annapolis, USA
01.2015 - 07.2015
- Managed relationships with lobbyists, advocacy groups, constituents, and other stakeholders on behalf of the elected official.
- Developed and implemented legislative strategies to advance policy objectives.
- Collaborated with colleagues on legislative strategy initiatives.
- Prepared briefing materials for hearings or floor debates.
- Advised the elected official on pertinent political considerations associated with various pieces of legislation.
- Monitored state and federal legislative activities, tracked bills, and reported relevant developments to elected official.
- Assisted in developing policy positions for the legislator.
Legislative Bill Drafter
Hawaii State Legislature
Honolulu, USA
10.2011 - 01.2014
- Acted as SME in Human Services, Healthcare, Medicaid, education, vocational licensing, and finance issues.
- Analyzed national policy trends, statistics, and current regulation clarifications.
- Revised and drafted various legislative proposals, including appropriation bills.
- Carried out interim research focusing on health care analysis and social welfare programs, including the Medicaid Buy-In Program.
- Prepared committee reports for legislative proposals in finance, ways and means, health and human services, and education committees.
- Evaluated suggested legal provisions for adherence to drafting standards and regulations.
- Monitored legislative proposals during the session for updates and modifications.
- Created over 100 bills each year.
Americorps Advocate/ Clerk
Legal Aid Society of Hawaii
Honolulu, USA
10.2010 - 10.2011
- Participated in community outreach events providing resources on immigrant rights.
- Answered inquiries from clients regarding the progress of their cases.
- Analyzed legal documents for discrepancies to streamline procedures and avoid delays.
- Collaborated with attorneys in preparing briefs summarizing findings for court proceedings.
- Translated immigration documents to explain relevance to potential residents.
- Conducted research into relevant laws and regulations related to immigration matters.
- Interpreted U.S. Immigration laws for individuals seeking permanent residence or naturalization status.
Education
Juris Doctorate - Law
University of Nevada
Las Vegas05.2010
Bachelor of Arts - Political Science and Public Policy
University of Maryland
Baltimore County05-2006
Skills
- Policy writing
- Regulatory compliance
- Data analysis
- Strategic planning
- Innovative problem solving
- Insurance regulations
Languages
- English, Native
- Korean, Advanced
Certification
- Contracting Officer's Representative
- Government Project Manager
Languages
Korean
Native/ Bilingual
Affiliations
- Cooking and Baking
- Fostering Dogs
References
References available upon request.
Timeline
Health Insurance Specialist
Center for Medicare and Medicaid Services, CMMI
03.2022 - Current
Associate Director, Medicare and Retirement, Regulatory Affairs
UnitedHealth Group, UHC
12.2021 - 02.2022
Consultant, Regulatory Affairs
United Health Group, Optum
11.2016 - 12.2021
Health Insurance Specialist
Center for Medicare and Medicaid Services, OHI
07.2015 - 07.2016
Chief of Staff
Office Delegate Aruna Miller
01.2015 - 07.2015
Legislative Bill Drafter
Hawaii State Legislature
10.2011 - 01.2014
Americorps Advocate/ Clerk
Legal Aid Society of Hawaii
10.2010 - 10.2011
Juris Doctorate - Law
University of Nevada
Bachelor of Arts - Political Science and Public Policy
University of Maryland
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