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ATTAC Consulting Group’s Leadership and Consulting Team

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ATTAC Consulting Groups’ (ACG’s) consulting team members bring our clients immediately relevant industry knowledge and experience from past operating and government roles, as well as years of expertise crafting solutions and conducting audits for a broad array of clients across the country.  This breadth of hands-on operational and regulatory experience allows us to quickly assess the complexities that your organization faces and to bring concrete and detailed solutions to implement.

Consulting Team

Kim Bresnan, Program Lead, Risk Adjustment

Kim Bresnan brings over 25 years of healthcare experience with the last 12 years dedicated to the management of Medicare Advantage, Medicare Part D, and ACA (Health Exchange) risk adjustment operations. She is proficient in risk adjustment program and process design and redesign, HCC risk adjustment payment methodologies, RA vendor management and revenue management.  She successfully introduced and incorporated system solutions supporting best practice process strategies for payment reconciliation while optimizing health plan revenue and quality of care, increasing productivity, and strengthening compliance. Kim held senior roles with Altegra Health as Vice President of Product Strategy & Development, and Verisk Health where she was Executive Vice President of Client & Market Strategy.  Previously, Kim held leadership roles with industry-leading managed care health plans including WellPoint (Anthem) and Aetna where she directed, led, and integrated revenue and quality initiatives.

Sharon F. Clackum, Pharm.D, Sr, Consultant, Pharma

Sharon is a member of ACG’s clinical pharmacy team supporting Medicare Part D, Medicaid, and pharmacy benefit management groups. Sharon has extensive experience in integrated clinical practice, formulary management, operational process reengineering and PBM oversight. She has designed and implemented utilization management programs for long-term care provider groups (Medicare Part A/ managed care) and has organized and participated on corporate JCAHO certification teams, for both skilled nursing facilities and pharmacies. Her experience as both a clinical pharmacist and national manager provides unique qualifications and insights into the internal workings of a broad scope of healthcare environments, including acute care, chronic care, long term care (LTC), and Medicare/Managed care arenas. She has over 20 years of healthcare industry experience and has worked for RX Answers and Phamerica, as well as serving on the Board of Directors for the American Society of Consultant Pharmacists.

Laurie Forrester, Pharm.D., Sr. Consultant, Pharma

Laurie is part of ACG’s clinical pharmacy practice group serving all program segments. She has extensive experience in clinical and operational management of pharmaceutical services in a complete scope of healthcare environments, including Medicare health programs, acute care and LTC arenas. Her multi-industry expertise has included integrated clinical and operational strategic planning, pharmacy network oversight, PBM oversight, pharmaceutical contract evaluation and negotiation, and process reengineering to enhance margin and compliance. She is a co-author of CMS Star Rating analysis and performance improvement tool-kit. Laurie is a member of the American Society for Consultant Pharmacists (ASCP) and the Academy of Managed Care Pharmacy (AMCP).

Robin Spletzer, Pharm. D, Consultant, Pharma, FWA

Robin is a member of ACG’s Pharmacy, Medicare Part D and Government Programs Group.   Robin brings ACG clients over 25 years of clinical pharmacy expertise managing formularies, PBM formulary system and testing, institutional pharmacy management (SNF), Clinical pharmacologic research and reviews in support of P & T committees, Medicare Part D formulary and operational requirements and pharmacy fraud, waste and abuse detection, investigation and interaction with MEDICs and law enforcement.   Over her career, Robin has held positions with the National Benefit Integrity Medicare Drug Integrity Contractor (NBI MEDIC Contractor) as well as with Procter & Gamble Pharmaceuticals, Express Scripts and Omnicare

Angela Hardy, Pharm.D., Consultant, Pharma Ops

Angela has over 15 years of experience and leadership in commercial and Medicare pharmaceutical program management with management expertise in Medicare Part D operations and regulatory compliance, medication therapy management, chronic disease management as well as in development of prescriber and patient educational programs designed to support formulary adherence and patient drug therapy adherence.  She has previously worked for organizations such as Constellation Health, LLC, BeneCard, Total Therapeutic Management and Kaiser Permanente.

Kimberly Vernachio, PharmD., Consultant, Pharma Analytics

Kimberly is a member of ACG’s pharmacy practice. She has had extensive responsibilities providing high-quality, customer-focused consulting services to Managed Care Organizations and the Pharmaceutical Industry. Her specializations include Medicare Part D and commercial (QHP) formulary development, drug and pharmacy data analytics, management and operations, FWA of controlled substance utilization programs, and drug utilization and review.

Margaret Jindra, RN, BSN, Sr. Consultant, UM/QA

Margaret is a member of ACG’s Clinical Management and Government Programs groups. She provides ACG clients with over 35 years of healthcare administration experience with expertise in Utilization, Quality and Case Management program design, and implementation with focus on effective use of data for population targeting and management. Margaret’s broad experience includes developing and implementing Model of Care (MOC) for Medicare Special Needs Plans. Prior to joining ATTAC Consulting Group, Margaret held senior roles at CareMore Health Plan, Healthcare Partners, Matria Healthcare, Blue Shield of California and CarePath.

Helene Jo, RN, MPH, Sr. Consultant, UM/QA, SNPs

Helene is a member of ACG’s Clinical Management and  Government Programs Groups.   Helene brings to clients expertise in practical implementation of clinical and quality operations in the areas of commercial health plans, managed Medicaid, Medicare Advantage and Dual programs, Special Needs Plan (SNP) Model of Care, Medicare STARs, CAHPS, HOS and other Quality Programs and NCQA Accreditation.  She has extensive experience in management of delegated provider groups and California DMHC requirements.  Her past roles have included serving as Director Regulatory Compliance and Director of Quality for Blue Shield of California, VP of Quality Improvement at Arcadian Health Plans and VP of Quality Programs at Bravo Health (now part of Cigna).

Sheila Muller, RN, BS, Sr. Consultant, UM/QA, Audit

Sheila is a member of ACG’s Clinical Management and Government Programs groups, specializing in the areas of managed Medicaid, Medicare and Dual programs, Special Needs Plans (SNP), federal and state regulations, risk management, and clinical operations. She has worked with the California Department of Managed Care (DMHC), NCQA, and URAC. Her past roles include Executive Director of Clinical Services and Long Term Care Operations at Presbyterian Health Plan in Albuquerque, Director of UM, QM and Credentialing for CareMore Health Plan in CA, and Director of Accreditation and Credentialing at Blue Shield of California.

Angela Beattie, RN, Sr. Consultant, UM/QA, MOC, NCQA

Angela is a member of ACG’s Clinical Management and Government Programs groups, specializing in the areas of Special Needs Plans (SNP), federal and state regulations, risk management, and clinical operations.  Angela is also an NCQA SNP-MOC Reviewer.

Carol Rohn, BSN, MBA, Sr. Consultant UM & QA

Carol s a member of ACG’s Medical Management, Quality Improvement and Government Programs teams. She brings over 20 years of experience focused on development and implementation of medical management systems, including utilization management, case management, disease management, quality improvement programs, clinical data systems, NCQA accreditation and strategic planning. Over her career, she has held positions as Vice President for Health Services and National Director for Clinical Delivery with AmeriChoice and Prudential Health Care. Her experience includes extensive work in Medicare Advantage and Medicaid programs along with private commercial products.

Darlene Dulac, Sr, Consultant, Compliance & Audit

Darlene is a member of ACG’s Government Programs Practice Group. She brings broad expertise in organizational development and compliance management in the Medicare and Medicaid arenas. For over a dozen years, she has held senior legal and compliance roles within the insurance and managed care industries, where she has led activities as diverse as health plan start-up, management of JCAHO and NCQA accreditation, state and CMS regulatory oversight audits, managed line responsibility for grievances and appeals, sales agent oversight and market conduct along with business processes and policy for corporate record retention. She has previously worked for Centene Corporation, AmeriGroup and United Healthcare.

Rick Evans, Sr. Consultant, Compliance & Audit

Rick is a member of ACG’s Government Programs and Health Plan Operations groups, consulting on compliance management and oversight as well as fraud, waste and abuse program development and implementation. Rick consults on Medicare Advantage and Medicare Part D program implementation and compliance monitoring, including grievance and appeals, claims payment, COB processes, Part D transition management and PDE management business processes. Over his almost 20 years in the industry, Rick has held senior compliance and FWA auditing roles with organizations such as United Health Care, National States Insurance and American National Insurance.

Cindy Hedges, Consultant, Compliance & Audit

Cindy is a member of ACG’s Government Programs group. She leads clients in health plan operations and compliance monitoring activities, specializing in licensure and regulatory interface, enrollment, customer service, grievance, appeal, CTM complaint management, marketing, sales oversight, HIPAA, internal and downstream delegate oversight and training program development across all operational arenas. Cindy also specializes in Accountable Care Organization (ACO) compliance programs. Her operational and compliance experience crosses Medicare, Medicaid and Commercial lines of business. She previously held senior compliance and oversight roles at WellCare Health Plans, Windsor Health (serving as CCO), and the Tennessee Department of Commerce and Insurance, with responsibility for oversight of various TennCare program plans.

Mark Andes, Consultant, Compliance & Audit

Mark Andes brings ACG’s clients critical guidance, broad knowledge and extensive operating experience in implementing successful compliance programs for government health care programs.  This includes Medicare Advantage, Part D, Medicaid (Medi-Cal,) and duals programs.  Over a span of 20 years Mark held roles of Chief Compliance Officer and Medicare Compliance Officer for organizations such as Blue Shield of California, MD Care Health Plan, AIDS Healthcare Foundation, Molina Healthcare and Anthem/WellPoint.  Mark specializes in developing effective compliance partnerships with business operating units and delegated entities that is focused on implementing process controls and data based monitoring to assure compliance with regulatory requirements.   He has extensive experience in compliance program design for broadly delegated operations, working with IPAs and Medical Groups.   In addition to managing operating compliance, Mark also specializes in implementing controls and monitoring compliance with the requirements of HIPAA Privacy and Security regulations.

Cathy McLean-Gordon, Sr. Consultant, Operations

Cathy McClain Gordon brings ACG clients more than 20 years of experience with Commercial programs, including HIX, and Government-sponsored programs (Medicare Advantage, Medicaid and TRICARE) as well as a passion for transforming health plan operations, establishing process controls to meet regulatory compliance requirements, quality management, provider network contracting and maintenance, technology implementations, and business development.

Over the years, Cathy has leveraged her expertise to aid clients in launching new lines of business, managing financial risk arrangements by developing and deploying successful risk adjustment strategies, preparing for delegation oversight and monitoring, developing care coordination models, executing provider network incentive models, and employing quality improvement strategies to meet CMS 5-Star, HEDIS, State and health plan quality measures.

Prior to joining ACG, Cathy worked for another nationally recognized consulting firm, various MAOs, Management Service Organizations (MSO) and commercial insurers leading healthcare reform implementation and process improvement initiatives, implementing delegation oversight and monitoring, executing internal corrective action plans, developing program controls, provider network contracting, driving population health management strategies and executing risk adjustment strategies. She also led various technology assessments and implementations.

Mae Regalado, Sr. Consultant, Operations & Systems

Mae is a member of ACG’s Health Plan Operations and Government Programs groups. Mae brings ACG’s clients over 20 years of experience in health plan operations, including claims management system configuration, business process design, workflow development, process interfaces and quality and process control implementation. Mae has extensive experience in assessing and developing operational processes within complex, delegated and/or matrixed environments. She brings broad experience in commercial, Medicare Advantage, and various state Medicaid programs to bear on client engagements. She has had broad expertise in the major information systems used within the health insurance industry.

Tom Middleton, Sr. Consultant, Operations & Systems

Tom is a member of ACG’s Plan Operations team, bringing clients over 20+ years of operations expertise from holding senior operations rolls in claims operations.   Tom has held senior operations roles with industry leading organizations including Superior Vision, Centene Corporation, WellCare Health Plans and Humana.   Tom has also led and supported a broad array  systems implementation and configuration projects across claims, enrollment and authorization sub-systems among others, both for in-house and out-sourced and ASP platforms as Director of Delivery Services for Health Edge and Director of Client Services Implementation for E4E Healthcare.   Because of his extensive background in claims, health data and data flows, Tom also has supported organizations in Risk Adjustment process reengineering and enhancement engagements.  In addition to his direct operational roles Tom has previously served on the consulting staff of Accenture.

Jill Croucher, Sr. Consultant, Operations & Systems

Jill is a member of ACG’s Medicaid Programs group, providing clients support in Medicaid RFP response, operational development to support specific state requirements, systems configuration and implementation, systems testing, business process design, process controls and reporting to state agencies.   Jill specializes in system management, enrollment and other transactional operations and data interfaces with state agencies related to Medicaid programs.   Prior to joining ACG, Jill held positions with organization such as Mercer Consulting and Arizona Health Care Cost Containment System (AHCCCS).

Linda Hagen, Sr. Consultant Operations & Systems

Linda is a member of ACG’s Information Technology, Health Plan Operations and Government Programs Practice Groups. She brings over 20 years of private and public sector systems, architecture, application, data management business process engineering, quality management and project management expertise to clients serving the health insurance and managed care industries. Her emphasis is on HIPAA compliance in data management along with state Medicaid MMIS claims payment and EQRO systems and management of encounter data at the health plan level. She has previously worked with United Health Care, Mercer Consulting, Health Services Advisory Group and Affiliated Computer Services Corporation (ACS).

Kimberly Bideau, Consultant, Compliance & Audit

Kim is a member of ACG’s Government Programs, Health Plan Operations and Compliance Groups. Kim specializes in compliance program design and operations for organizations serving Medicare, Duals and commercial populations.   She has extensive experience in CMS Program Audits, including Compliance Program Effectiveness (CPE) and Financial Audit preparation, internal auditing and monitoring programs, department level operational compliance monitoring, risk assessments and regulatory interpretation.    Kim also brings clients in depth experience in appeal, grievance and customer service operations management as well as management if IRE review processes.    Kim previously served as Manager Compliance Audit for Independence Blue Cross and Manager, Medicare Compliance for Aetna, Inc.

Erin Miskell, JD, Consultant, Compliance & Audit

Erin Miskell is a member of ACG’s Government Programs and Compliance Groups.   She is an accomplished project manager who led enterprise-wide initiatives to restructure compliance oversight of delegated provider entities, off-shored operations, sales and marketing agents and other delegates including creation of pre-delegation review programs, audit tools, design of required data feeds and monitoring programs.   In addition she has been responsible for state regulatory interface for a multi-state organization for commercial, Medicare and Medicaid programs.   She has been a key participant in the implementation process for multiple state Medicaid MCO programs.    Erin also specializes in management of appeals, grievances and for Medicare programs Complaint Tracking Module (CTM) processes and work-flows.    She holds her J.D. from the University of South Carolina School of Law.

Al Steindorf, MBA, Sr. Consultant, Finance

As a member of ACG’s Health Plan Management, M & A, and Government Programs groups, Al provides clients expertise in finance and accounting issues in all product sectors of the insurance and managed care industries, including finance and reconciliation for Medicare Advantage and Part D programs. Al has consulted and held interim CFO roles through numerous plan reorganizations and restructurings during M & A transactions and receiverships. He has also led forensic accounting initiatives on distressed and acquired companies. Over his 25-year industry career, Al has held CFO roles for Sutter Connect, Wisconsin Health Organization and senior finance roles with numerous Blue Cross and Blue Shield plans, as well as serving on the consulting team at The Pace Group.

Jan Smith, CPA, Consultant, Audit & Finance

Jan is a member of ACG’s finance, operations and audit teams supporting Government programs with specialties in Medicaid and Medicare programs.

Nalini Rambahal, MBA, Consultant, Data Audit & Compliance

Nalini is a member of ACG’s Data Audit and Compliance Solutions teams.  She brings clients over 8 years of experience in project management and leadership in managing internal audit activities in data focused arenas such as claims and process focused arenas such as HIPAA compliance.   She has also worked extensively in analysis of data to conduct risk assessments of various elements of operations.    Prior to joining ACG, Nalini held various management and audit roles within Cigna, Inc., Elder Plan of New York and Horizon BCBS.

Tina Gallagher, MBA, Provider Network Management

Medicare, Medicaid, Exchange subject matter expert with 25+ years’ experience in Government Sponsored healthcare. C-Suite level expertise in Managed Medicaid and Managed Medicare, skilled in managing all aspects of Health Plan Operations to include: P&L, policy, general management, network development, RFP response, policy, implementation, regulatory and compliance, while maximizing efficiency and effectiveness. She has led numerous consulting engagements and is experienced in lobbying for health care reform.
Currently leading ATTAC Consulting Group’s (ACG) Provider Network Management and Payer Innovation / Population Health service offerings. Founded in 2003, ATTAC Consulting Group (ACG) has been recognized as a premier national consulting and auditing firm serving insurers, managed care and provider organizations. ACG’s network development team is one of the nation’s largest, bringing clients broad coverage along with, strong experience in assessing and developing high performance provider networks. ACG specializes in provider network development and management, regulatory compliance, program development, business process engineering and auditing, along with medical and pharmacy management.

 

Prior to joining ATTAC Consulting Group, Ms. Gallagher held State Plan President positions for United Health Group (TX); Molina Healthcare of MO; served as Executive Director (MO and Southern Illinois) with responsibility for regional and statewide health plan performance; and various leadership positions within Coventry (MO).
Building and managing effective provider networks is the foundation for managing cost and member/provider satisfaction. ACG’s strong experienced team offers a flexible approach to our clients and expertise spread across the United States.
ACG’s network development team is one of the nation’s largest, bringing clients broad coverage along with, strong experience in assessing and developing high performance provider networks

Ashleigh Majdeski, Provider Network Operations

Ashleigh is the Practice Leader for ACG’s Provider Network Operations Team. Ms. Majdeski dedicates herself to develop, manage and drive uniformity, efficiencies and consistencies within Operations including provider relations, process improvement, network analysis and credentialing. She also provides a wealth of contracting background from the physician and health plan perspective. Ashleigh also leads clients through merger/acquisition integration including providing “On Demand” interim placement. Ashleigh previously held leadership roles at Universal American, AmeriHealth Caritas and served as the Provider Network Contracting Manager and Credentialing Manager of a national firm before joining the ACG team.

Amy Krause, MBA, Provider Network Development

Amy brings over 20 years’ experience working on behalf of health plans and providers on initiatives across Commercial, Medicare Advantage and Medicaid lines of business. She has specialized expertise in network analysis and performance, contract negotiations and strategy development. Amy works with clients to assess performance over various network indicators, conduct contract analysis and optimization across reimbursement and language provisions, review payor mix and compensation against benchmarks, perform audits to prepare for regulatory and compliance reviews, and identify plans for remediation. Amy also develops strategy and responses for Medicaid RFPs, and creates written materials such as provider manuals, policies and procedures, and network development plans. Prior to consulting Amy worked in health care management roles for UnitedHealthcare, CIGNA of Arizona, and PacifiCare of Arizona. She holds a master’s Degree in Business Administration from the State University of New York at Buffalo.

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