Teams at Devoted Health

Oversee Special Needs Plan operations, regulatory compliance, Model of Care development, CMS and Medicaid requirements, documentation, reporting, and audit readiness. Translate changing regulations into workflows, improve operational processes, develop Medicaid benefit expertise, and collaborate cross-functionally to ensure accurate compliance and effective support for frontline teams and members.

Oversee claims benefit configuration, including setup, analysis, mapping, testing, auditing, troubleshooting, and implementation. Maintain accurate member cost sharing, benefit limitations, provider payment information, authorization rules, and denial-code mappings. Lead annual benefit readiness and BID application management, coordinate cross-functional teams, manage configuration inquiries, enforce quality controls, and implement process improvements to reduce errors and improve operational efficiency.

Leads provider data accuracy and directory compliance for a health plan, including validation, verification, remediation, CMS requirements, audit readiness, metrics, and regulatory responses. Manages and scales onshore and offshore teams, improves risk-based verification infrastructure, partners with product and engineering on automation and directory strategy, supports care navigation, and oversees vendors. Translates provider data insights into operational improvements, measurable quality outcomes, and executive reporting.