Experienced healthcare professional with a strong background in regulatory expertise, specializing in federal Medicare policy and regulations. Proven ability to understand and implement accrediting organization (AO) requirements for all Medicare-certified programs. Actively involved as a Medicare expert and representative to all CMS-approved accrediting organizations, overseeing and enforcing activities to ensure compliance.
Overview
18
18
years of professional experience
1
1
Certification
Work History
Health Insurance Specialist GS-13
Centers for Medicare & Medicaid Services (CMS)
04.2007 - Current
Conduct analytical studies of AO oversight program (9 national Accrediting Organizations that consists of 23 approved medicare programs) and operational processes for all aspects of the accreditation programs approved by CMS;
Provide technical guidance to CMS-approved accrediting organizations, Regional Offices, State Survey Agencies, and healthcare facilities;
AO application team lead. Review and coordinate the review of all AO applications for CMS approval, including accreditation standards, survey process, and use of data;
100 percent success rate in completing application reviews on time and publishing the final notices on time.
Responsible for evaluation and process improvement activities of CMS’ AO oversight and application review process to ensure that facilities comply with Medicare requirements;
Make recommendations to senior leadership related to enhanced oversight for deeming authority;
Develop policies and procedures to be used by internal and external groups related to all aspects of AO oversight;
Review and revise survey and certification policy, State Operation Manual, and interpretive guidelines to develop operational policies related to accrediting organizations;
Provide technical assistance to stakeholders in the resolution of accreditation and deemed status issues;
Prepare briefings for meetings and hearings;
Collaborate with key officials and groups within and outside the CMS to resolve problems pertaining to accreditation and deemed status;
Participate in briefings, hearings, and other meetings to disseminate information;
Subject matter expert (SME) for Psychiatric Residential Treatment Facilities, Community Mental Health Centers, ICF/IID Facilities, and Rural Emergency Hospitals programs;
Assist team in developing and/or updating interpretive guidance, revising the State Operations Manual and ASPEN related to Psychiatric Residential Treatment Facilities, Community Mental Health Centers, ICF/IID Facilities and Rural Emergency Hospitals, to address changes in statute and regulations;
Serve as Contracting Officer Representative for Report to Congress contract
Consistently track and review the contract’s progress, meeting contract deadlines with satisfactory deliverable, and the assessment of these factors with the Scope of Work
Health Insurance Specialist GS-14 temporary promotion
Centers for Medicare & Medicaid Services (CMS)
03.2024 - 07.2024
Provided expert technical advice and assistance to senior managers and staff to assure the accomplishment of the goals and objectives of the strategic plans for CMS, CCSQ, and QSOG;
Oversaw and provided technical advice related to Medicare certification and enforcement policies for division programs;
Coordinated team member activities related to evaluation and oversight of the division programs;
Provided timely oral and written expert guidance, technical assistance and consultation pertaining to regulations and policies and related data systems;
Served as a resource person and technical authority and coordinated cross-cutting projects, tracked all meetings/action items and deliverable for both the Director and Branch manager, including regulations and other sensitive matters, and conducted special assignments on a wide range of significant management, and operational, and policy issues
Health Insurance Specialist GS-14 temporary promotion
Centers for Medicare & Medicaid Services (CMS)
07.2022 - 10.2022
Provided expert technical advice and assistance to senior managers and staff to assure the accomplishment of the goals and objectives of the strategic plans for CMS, CCSQ, and QSOG;
Oversaw and provided technical advice related to Medicare certification and enforcement policies for division programs;
Coordinated team member activities related to evaluation and oversight of the division programs;
Provided timely oral and written expert guidance, technical assistance and consultation pertaining to regulations and policies and related data systems;
Served as a resource person and technical authority and coordinated cross-cutting projects, tracked all meetings/action items and deliverable for both the Director and Branch manager, including regulations and other sensitive matters, and conducted special assignments on a wide range of significant management, and operational, and policy issues;
Assisted team in development of interpretive guidance for new provider (Rural Emergency Hospitals)
Validation Program Lead
Centers for Medicare & Medicaid Services (CMS)
09.2014 - 09.2019
Coordinated validation surveys for all accreditation programs;
Responsible for making sure survey schedule information is received from AOs on time to support AO performance assessment through validation surveys;
Provided CMS Regional Offices (ROs) with monthly notification of hospital and non-hospital facilities selected for validation survey by the State Survey Agencies;
Responsible for providing accurate and complete information authorizing payments by budget staff to the State Survey Agencies for supplemental surveys;
Participated in periodic calls with the ROs to facilitate timely and consistent implementation of the validation program;
Responsible for drafting, revising, and finalizing written policies and procedures for Validation Survey Program;
Reviewed validation team analysis and finalized for review by Senior Leadership annually
Including the number of validation surveys targeted; number assigned; number completed; number assigned, but not completed; and, reason not conducted, by program type, state, and region;
SME for the CMS Validation Redesign Pilot Project- provided guidance on site selection and ensured the team functioned within confines of the Mission Priority Document (budget - quote) (MPD) and regulation
Education
Master of Science - Health Services Administration
Towson University
12.2006
Bachelor of Science - Healthcare Management, Business Administration
Towson University
05.2003
Skills
Policy analysis
Teamwork and collaboration
Problem-solving abilities
Organizational skills
Decision-making
Time management
Training
Contract Officer Representative II, 2009, Centers for Medicare & Medicaid Services, Baltimore, MD
Federalgovernmentexperience
Centers for Medicare & Medicaid Services (CMS), Baltimore, MD, 04/2007, present, Health Insurance Specialist GS-13, Conduct analytical studies of AO oversight program and operational processes for all aspects of the accreditation programs approved by CMS., Provide technical guidance to CMS-approved accrediting organizations, Regional Offices, State Survey Agencies, and healthcare facilities., Review and coordinate the review of all AO applications for CMS approval, including accreditation standards, survey process, and use of data., Responsible for evaluation and process improvement activities of CMS’ AO oversight and application review process., Make recommendations to senior leadership related to enhanced oversight for deeming authority., Develop policies and procedures to be used by internal and external groups related to all aspects of AO oversight., Review and revise survey and certification policy, State Operation Manual, and interpretive guidelines to develop operational policies related to accrediting organizations., Provide technical assistance to stakeholders in the resolution of accreditation and deemed status issues., Prepare briefings for meetings and hearings., Collaborate with key officials and groups within and outside the CMS to resolve problems pertaining to accreditation and deemed status., Participate in briefings, hearings, and other meetings to disseminate information., Subject matter expert (SME) for Psychiatric Residential Treatment Facilities, Community Mental Health Centers, ICF/IID Facilities, and Rural Emergency Hospitals programs., Assist team in developing and/or updating interpretive guidance, revising the State Operations Manual and ASPEN related to Psychiatric Residential Treatment Facilities, Community Mental Health Centers, ICF/IID Facilities and Rural Emergency Hospitals, to address changes in statute and regulations., Serve as Contracting Officer Representative for Report to Congress contract. Consistently track and review the contract’s progress, meeting contract deadlines with satisfactory deliverable, and the assessment of these factors with the Scope of Work.
Centers for Medicare & Medicaid Services (CMS), Baltimore, MD, 03/2024, 07/2024, Health Insurance Specialist GS-14 temporary promotion, Provided expert technical advice and assistance to senior managers and staff to assure the accomplishment of the goals and objectives of the strategic plans for CMS, CCSQ, and QSOG., Oversaw and provided technical advice related to Medicare certification and enforcement policies for division programs., Coordinated team member activities related to evaluation and oversight of the division programs., Provided timely oral and written expert guidance, technical assistance and consultation pertaining to regulations and policies and related data systems., Served as a resource person and technical authority and coordinated cross-cutting projects, tracked all meetings/action items and deliverable for both the Director and Branch manager, including regulations and other sensitive matters, and conducted special assignments on a wide range of significant management, and operational, and policy issues.
Centers for Medicare & Medicaid Services (CMS), Baltimore, MD, 07/2022, 10/2022, Health Insurance Specialist GS-14 temporary promotion, Provided expert technical advice and assistance to senior managers and staff to assure the accomplishment of the goals and objectives of the strategic plans for CMS, CCSQ, and QSOG., Oversaw and provided technical advice related to Medicare certification and enforcement policies for division programs., Coordinated team member activities related to evaluation and oversight of the division programs., Provided timely oral and written expert guidance, technical assistance and consultation pertaining to regulations and policies and related data systems., Served as a resource person and technical authority and coordinated cross-cutting projects, tracked all meetings/action items and deliverable for both the Director and Branch manager, including regulations and other sensitive matters, and conducted special assignments on a wide range of significant management, and operational, and policy issues., Assisted team in development of interpretive guidance for new provider (Rural Emergency Hospitals).
Centers for Medicare & Medicaid Services (CMS), Baltimore, MD, 09/2014, 09/2019, Validation Program Lead, Coordinated validation surveys for all accreditation programs., Responsible for making sure survey schedule information is received from AOs on time to support AO performance assessment through validation surveys., Provided CMS Regional Offices (ROs) with monthly notification of hospital and non-hospital facilities selected for validation survey by the State Survey Agencies., Responsible for providing accurate and complete information authorizing payments by budget staff to the State Survey Agencies for supplemental surveys., Participated in periodic calls with the ROs to facilitate timely and consistent implementation of the validation program., Responsible for drafting, revising, and finalizing written policies and procedures for Validation Survey Program., Reviewed validation team analysis and finalized for review by Senior Leadership annually. Including the number of validation surveys targeted; number assigned; number completed; number assigned, but not completed; and, reason not conducted, by program type, state, and region., SME for the CMS Validation Redesign Pilot Project- provided guidance on site selection and ensured the team functioned within confines of the Mission Priority Document (budget - quote) (MPD) and regulation.
Accomplishments
Collaborated with team of 7 in the development of policy for new rural emergency hospital program.
Used Microsoft Excel to develop tracking spreadsheets to help answer technical questions received for the development of the program.
Achieved [Result] by completing [Task] with accuracy and efficiency.
Achieved [Result] through effectively helping with [Task].
Certification
Contracting Officer Representative II
Timeline
Health Insurance Specialist GS-14 temporary promotion
Centers for Medicare & Medicaid Services (CMS)
03.2024 - 07.2024
Health Insurance Specialist GS-14 temporary promotion
Centers for Medicare & Medicaid Services (CMS)
07.2022 - 10.2022
Validation Program Lead
Centers for Medicare & Medicaid Services (CMS)
09.2014 - 09.2019
Health Insurance Specialist GS-13
Centers for Medicare & Medicaid Services (CMS)
04.2007 - Current
Bachelor of Science - Healthcare Management, Business Administration
Towson University
Contracting Officer Representative II
Master of Science - Health Services Administration
Towson University
Similar Profiles
Lillian WilliamsLillian Williams
Health Insurance Specialist GS-13 at Centers for Medicare & Medicaid Services (CMS)Health Insurance Specialist GS-13 at Centers for Medicare & Medicaid Services (CMS)
Oracle Applications Senior Manager at General Dynamics IT, Center for Medicare & Medicaid Services, CMSOracle Applications Senior Manager at General Dynamics IT, Center for Medicare & Medicaid Services, CMS