RONALD MCGINNIS
Signal Hill,CA
Summary
Performance-driven Vice President with over 25 years of experience aligning systems with business requirements, policies, and regulatory requirements. Passionate about applying excellent organization and communication skills to manage and lead teams. Results-oriented individual well-versed in interfacing and consulting on business processes to drive results based on sound overall business judgment.
Overview
33
33
years of professional experience
Work History
Vice President of Compliance & Privacy
VERDA HEALTHCARE
Huntington Beach, CA
01.2024 - 12.2024
- Reporting directly to the CEO and responsible for overseeing and monitoring the Compliance and Privacy Program for Texas, CA, AZ
- Responsible for overseeing internal quality monitoring and collaborating with Operation Business owners in supporting ongoing readiness for Federal and State audits
- Oversee and audit all downstream vendors operations and compliance
- Maintain collaborative and positive working relationships with Federal and State auditors
- Fulfill all health plan reporting requirements
- Work closely with the operations on developing and monitoring Key Performance Indicator metrics
- Responsible for overseeing privacy incidents and breaches
- Increased company growth through collaboration with sales and marketing departments.
- Position eliminated and all Compliance oversight done by external law firm.
Hybrid Compliance & Privacy Officer
Santa Clara Family Health Plan
San Jose, CA
06.2023 - 09.2023
- Reporting directly to the Vice President, Government Relations, and Compliance and responsible for overseeing, monitoring, and periodically revising the compliance program for the organization in accordance with State and Federal requirements for CalAIM and Medicare Advantage
- Oversaw privacy incidents and breaches
- Serving as the subject matter expert and regularly interacting and providing oversight to the MSO, consulting on compliance best practices, Risk Management and leading internal DHCS and DMHC audits
- Resigned due to Hybrid roles being eliminated and all staff back into the Santa Clara office
Chief Compliance & Privacy Officer
AmericasHealth Plan
Oxnard, CA
07.2019 - 03.2023
- Reporting directly to the Interim CEO and responsible for overseeing, monitoring, and periodically revising the compliance program for the organization in accordance with State and Federal requirements for the 14 FQHC clinics in Ventura County
- Responsible for moving the plan from a restricted Knox-Keene License to an unrestricted Knox-Keene license
- Target Date is December 2021
- Conducts and/or direct audits, response and developing correcting action plans
- Chairs the monthly Compliance Committee meetings and provides compliance updates to the Board of Directors on a quarterly basis
- Responsible for overseeing privacy incidents and breaches
- Health Plan closed operations in March 2023
Vice President
MEDICARE COMPLIANCE SOLUTIONS
Signal Hills, CA
09.2018 - 06.2019
- Company Overview: (Privately owned Healthcare Consulting organization providing Medicare Compliance, Regulatory and Risk Assessment Services to Medicare Advantage and Medicare Part D Health Plans.) Managing Partners dissolved the Company in 2020
- Reported directly to the Managing Partners, responsible for providing compliance consulting to Medicare Health Plan clients
- Conducted and/or directed audits, response and developing correcting action plans
- Worked on RFP's and Business Development for new health plans with an emphasis on Medicare Business expansions in new markets
- Medicare Appeal & Grievance Subject Matter Expert
- (Privately owned Healthcare Consulting organization providing Medicare Compliance, Regulatory and Risk Assessment Services to Medicare Advantage and Medicare Part D Health Plans.) Managing Partners dissolved the Company in 2020
Vice President, Compliance
CLINICAL PARTNERS GROUP
Los Angeles, CA
10.2017 - 09.2018
- Company Overview: (Global Healthcare and Life Sciences Consulting organization specializing in CMS Compliance and TPA Services for Health Plans and Providers)
- Reported directly to the Managing Partner
- Responsible for providing strategic compliance consulting to healthcare clients 'Heal' and 'Butterfly.'
- Responsible for developing policies and procedures for HIPAA, FWA and building security review and developing Company's ethics and compliance mission statement
- Worked with Managing Partner on new Business Development in the Western Region with an emphasis on CMS compliance and TPA services for health plans and providers
- Medicare Appeal & Grievance Subject Matter Expert
- (Global Healthcare and Life Sciences Consulting organization specializing in CMS Compliance and TPA Services for Health Plans and Providers)
Western Region Corporate Compliance & Privacy Director
MOLINA HEALTHCARE INC.
Long Beach, CA
09.2015 - 10.2017
- Reported to the Corporate Chief Compliance Officer
- Responsible for overseeing the Medicare Advantage Part D, Marketplace, Medicaid and Dual eligible populations Compliance programs for California, New Mexico, Texas, Utah, Washington and Wisconsin Compliance Health Plans Directors and their support staff with over 1.8M members
- Managed 6 Compliance Officers and indirectly their support staff in multiple States
- Accomplishments included coordinating all aspects of Molina's Corporate and Health Plan level interface with compliance
- Departed as part of a company reorganization where Molina's corporate compliance department was severely reduced; position was eliminated
- Recruited, hired, and trained initial personnel, working to establish key internal functions and outline scope of positions for new organization.
Director of Compliance & Regulatory Affairs
WELLCARE
Cypress, CA
04.2013 - 09.2015
- Supported the Corporate Chief Compliance Officer with daily Compliance functions and oversight of the California Health Plans Medicare Advantage and Prescription program with oversight for 300K members
- Managed 1 Compliance Analyst
- Account Manager for Vendors and Downstream Delegates
- Responsible for completing the Quarterly Medicare Compliance and Risk reports for the Corporate Compliance Committee
- Achieved key compliance with the OIG Corporate Integrity Agreement
- Maintained effective working relationships with regulatory authorities, suppliers and customers.
Compliance Officer
UNITEDHEALTHCARE COMMUNITY & STATE
Honolulu, HI
05.2010 - 04.2013
- Reported to the Plan President and Chief Compliance Officer
- Responsible for overseeing and monitoring compliance for all business activities for the Medicaid, Duals and Special needs plans
- Supervised 2 Exempt FTEs 1 Manager, 1 Analyst
- Co-lead for NCQA, HSAG, CAHPS accreditation audits and surveys that resulted in excellent ratings and top box scores
- Played a key role in development and launch of home health care, providing research and development of compliance training requirements and securing approval for implementation
- Ensured proper maintenance and dissemination of Regulatory filing documentation as well as records and reports for review by various Departments
- Accepted an offer to move back to California
Western Region Director of Regulatory Management
ANTHEM BLUE CROSS
Woodland Hills, CA
11.2002 - 07.2009
- Reported to the Chief Medical Officer and Plan President
- Responsible for overall direction and compliance for the California, Colorado, and Nevada Medicare Advantage, Commercial and Behavioral Health Grievance & Appeals programs for over 1.5 million Members and Provider Disputes
- Supervised a staff of 8 Managers and 173 Nurses and over 75 administrative FTEs in multiple markets
- Improved the company Compliance and Quality rate for Medicare and Commercial from 80% to 98% within 6 months
- Responsible for the CalPERS Appeals & Grievances members
- Selected by the CEO for the exclusive Anthem Executive Experience Program and AHIP Executive Leadership Program within first year of hir
- Attended weekly meetings to discuss and optimize strategies.
- Regional Corporate changes eliminated Position
Director of Medicare Advantage Appeals & Grievances 'A&G' Program
BLUE SHIELD of CALIFORNIA
Los Angeles, CA
01.2000 - 10.2002
- Reported to the Senior Vice President of Operations and Customer Quality
- Responsible for the Commercial Member Appeals and Grievances team
- Worked jointly with the Medicare A&G Director on audits and best practices
- Increased overall timeliness and quality compliance within 1 year
- Directed a staff of 2 Managers and 50 individuals in the LA and Folsom office
- Worked directly with internal Operations teams to achieve full Compliance with all CMS, DMHC, NCQA and DOI regulators
- BSCA closed its Los Angeles office, and the Director Position was moved to El Dorado Hills
Director of Member Services
CALOPTIMA
Santa Ana, CA
01.1997 - 12.1999
- Reported to the Vice President, COO
- Functions performed included coordinating all the operations of CalOptima's Medicaid business, such as: review of Monthly accomplishments, Key Initiative Status Reports, Cross Organizational Meetings, Quarterly forecasts, and Metrics and updating the Orange County Board on enterprise-wide initiatives and undertakings
- Restructured the core health plan operations
- Prepared monthly, daily, and weekly statistical reports.
- Mutual Decision to resign and accept a severance package after COO that hired me, and other Executives resigned
Medicare Appeals & Grievance Manager
UNITEDHEALTHCARE
Cypress, CA
01.1992 - 12.1996
- Reporting to the Director of Member Services
- Managed the Medicare Appeals & Grievances process
- Managed approximately 30 FTE's that processed member Appeals & Grievances for CMS region 9
- Maintained oversight and compliance controls for monitoring inventory, production and member and provider service
- Lead on CMS annual audits, account management and developing Corrective Action Plans when needed
- Maintained positive customer relations by addressing problems head-on and implementing successful corrective actions.
- Established team priorities, maintained schedules and monitored performance
- Accepted a Director role with CalOptima
Education
MBA - Business
University of Phoenix
Los Angeles, CA07.1996
Bachelor of Science - Communications
University of Texas At Austin
Austin, TX05.1983
Skills
- Coaching and mentoring
- Leadership & Management
- Strategic Planning and Vision
- Financial Business Management
- Change Management
- Excellent verbal
- Presentations
- Staff training
- Team leadership
Timeline
Vice President of Compliance & Privacy
VERDA HEALTHCARE
01.2024 - 12.2024
Hybrid Compliance & Privacy Officer
Santa Clara Family Health Plan
06.2023 - 09.2023
Chief Compliance & Privacy Officer
AmericasHealth Plan
07.2019 - 03.2023
Vice President
MEDICARE COMPLIANCE SOLUTIONS
09.2018 - 06.2019
Vice President, Compliance
CLINICAL PARTNERS GROUP
10.2017 - 09.2018
Western Region Corporate Compliance & Privacy Director
MOLINA HEALTHCARE INC.
09.2015 - 10.2017
Director of Compliance & Regulatory Affairs
WELLCARE
04.2013 - 09.2015
Compliance Officer
UNITEDHEALTHCARE COMMUNITY & STATE
05.2010 - 04.2013
Western Region Director of Regulatory Management
ANTHEM BLUE CROSS
11.2002 - 07.2009
Director of Medicare Advantage Appeals & Grievances 'A&G' Program
BLUE SHIELD of CALIFORNIA
01.2000 - 10.2002
Director of Member Services
CALOPTIMA
01.1997 - 12.1999
Medicare Appeals & Grievance Manager
UNITEDHEALTHCARE
01.1992 - 12.1996
MBA - Business
University of Phoenix
Bachelor of Science - Communications
University of Texas At Austin
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