Shannon Drummond
Blue Cross and Blue Shield of North Carolina
Lexington,NC
19
years of professional experience
Results-driven Corporate Compliance Advisor with extensive experience managing Medicare Advantage, Part D, and regulatory compliance programs within the healthcare industry. Proven success coordinating CMS reporting requirements, contract administration, HPMS submissions, executive attestations, regulatory audits, and cross-functional compliance initiatives. Experienced partnering with business leaders, operational teams, legal, product, pharmacy, finance, and regulatory stakeholders to ensure compliance and audit readiness.
Work History
Corporate Compliance Advisor
7 Months- Lead compliance oversight activities for Medicare Advantage and Part D programs to ensure adherence to CMS regulations, contract requirements, and organizational policies.
- Manage CMS contract administration processes, including HPMS submissions, electronic contracting activities, executive attestations, contract reviews, and regulatory communications.
- Partner with business owners and cross-functional stakeholders to support implementation of regulatory requirements, compliance initiatives, and operational process improvements.
- Interpret CMS guidance and assess regulatory impacts to business operations, providing recommendations to support compliance and mitigate risk.
- Conduct compliance monitoring, risk assessments, and oversight activities to identify potential regulatory issues and facilitate timely remediation efforts.
- Review operational processes, policies, and procedures to ensure alignment with federal and state regulatory requirements and organizational standards.
- Coordinate corrective action plans and compliance remediation activities in partnership with Corporate Compliance and business leaders.
- Develop and maintain compliance documentation, standard operating procedures, governance materials, tracking tools, and reporting dashboards.
- Support Medicare bid cycle activities, regulatory filings, and CMS reporting requirements to ensure timely and accurate submissions.
Compliance Advisor
4 Years- Facilitate stakeholder communications, training, and awareness activities related to compliance requirements, regulatory changes, and CMS expectations.
- Collaborate with Legal, Product, Pharmacy, Finance, Operations, and Government Programs teams to ensure compliance considerations are incorporated into strategic initiatives and business processes.
- Monitor compliance-related projects and system enhancements to ensure appropriate controls, regulatory requirements, and audit readiness standards are maintained.
- Lead compliance oversight for Medicare Advantage and Part D programs, ensuring adherence to CMS requirements, regulatory mandates, and organizational policies.
- Manage CMS contract administration activities, including HPMS submissions, electronic contracting, executive attestations, contract documentation, and regulatory communications.
- Coordinate cross-functional initiatives with business owners, Legal, Product, Pharmacy, Finance, Operations, and Compliance stakeholders to support regulatory compliance and strategic business objectives.
- Conduct compliance risk assessments, monitoring activities, and audits to identify potential regulatory risks and ensure timely implementation of corrective actions.
- Review and evaluate operational policies, procedures, and business processes for compliance with federal and state regulations while identifying process improvement opportunities.
- Research and interpret CMS guidance and regulatory requirements, providing recommendations and compliance solutions to business partners and leadership.
- Support Medicare bid cycle activities, regulatory filings, and implementation of compliance-driven business initiatives.
- Develop compliance procedures, governance documentation, training materials, dashboards, and tracking tools to improve oversight and accountability.
- Manage remediation efforts and corrective action plans related to compliance findings, audit observations, and regulatory issues.
- Serve as a key liaison between business areas and Corporate Compliance to ensure appropriate controls, monitoring activities, and regulatory readiness across the organization.
Appeals Specialist
3 Years 8 Months- Lead a team of Resolution Coordinators by working directly with team members providing feedback and technical support regarding day to day training, processes, and production.
- Coordinate departmental activities to ensure compliances with current processes and procedures.
- Works with internal and external parties via phone, written and electronic correspondence to ensure all work is completed timely as required by regulatory agencies, accrediting bodies and BCBSNC policy.
- Responsible for the end to end process of timely completion of the Level 2 member appeals.
- Develop/implement training and other communications for Resolution Coordinators as needed.
Resolution Coordinator
3 Years 10 Months- Performs initial research and documentation of all incoming appeals and grievances.
- Responsible for determining the validity, setup, and assignment of all department requests.
- Provide mandated written responses to appellants of the status of their case(s).
- Subject Matter Expert. Provide assistance and direction to peers.
- Provides direct feedback to Appeals Department management for identified problems.
Support Specialist
1 Year 8 Months- Maintained and updated paper and electronic/database files.
- Coordinated and/or record incoming and outgoing work as needed for business area including ordering of supplies, reporting, tracking, monitoring and verifying receipt date and expected completion dates of outstanding work.
- Researched incorrect or missing information on correspondence.
- Entered in inpatient authorizations for inpatient members, assisted with any training needs.
Administrative Specialist
5 Years 2 Months- Provided support for Manager and Director of Engineering
- Processed work order request, Ordered/maintain office supplies, maintained all employee records, processed invoices, scheduled meetings and appointments for management/director
- Created Power Point presentations for monthly department meetings
- Handled incoming calls from internal and external customers, created work orders for all incoming request, data entry.
- Nominated and chosen to Employee of the quarter
Education
Juris Masters - Compliance
Bachelor of Science - Health and Business
Diploma - Medical Assistant and Office Technology
Skills
Medicare Advantage Compliance
Medicare Part D Compliance
CMS Regulatory Reporting
CMS Contract Administration
HPMS Administration
Regulatory Audits & Monitoring
Audit Readiness
Risk Assessment & Mitigation
Regulatory Interpretation
Policy & Procedure Development
Process Improvement
Cross-Functional Leadership
Executive Attestations
Enterprise Compliance Programs
Timeline
Corporate Compliance Advisor
Blue Cross and Blue Shield of North Carolina
03.2026 - CurrentRead More
Compliance Advisor
Blue Cross and Blue Shield of North Carolina
03.2022 - 03.2026Read More
Appeals Specialist
Blue Cross and Blue Shield of North Carolina
07.2018 - 03.2022Read More
Resolution Coordinator
Blue Cross and Blue Shield of North Carolina
09.2014 - 07.2018Read More
Support Specialist
Blue Cross and Blue Shield of North Carolina
01.2013 - 09.2014Read More
Administrative Specialist
Forsyth Medical Center
11.2007 - 01.2013Read More
Brookstone Business College
Diploma from Medical Assistant and Office Technology
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Liberty University
Bachelor of Science from Health and Business
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Liberty University
Juris Masters from Compliance
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