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.
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.
Chhaya has more than 18 years of clinical and compliance expertise in managing pharmacy benefit programs for Medicare Advantage, Medicaid and commercial health care benefit programs. This includes managing clinical operations for coverage determinations and formulary exceptions,
Prior to joining ATTAC Consulting Group, Chhaya served as a m
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.
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 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 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.
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.
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.
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.
Mia has more than 16 years of experience in regulatory compliance management with a specialization in compliance in clinical activities and oversight of behavioral health and substance abuse services. She
Prior to joining ACG, Mia served as senior compliance specialist for Centene and r
Ms. Miskell is an experienced and successful Medicare Advantage compliance professional with ten years of experience in the healthcare industry. Erin’s background includes leadership positions in Medicare sales compliance/agent oversight, compliance program effectiveness/administration, delegated entity oversight, and health plan operations. Erin is experienced with project management methodologies, managing project stakeholder responsibilities and expectations, and has led small teams of direct reports.
Medicare, Medicaid, Exchange subject matter expert with 25+ years’ experience in Government Sponsored healthcare. C-Suite level expertise in managing all aspects of Health Plan Operations to include: P&L, policy, strategy, plan management, network development, regulatory and compliance, while maximizing efficiency and effectiveness.
Tina is a key leader guiding ACG clients on Provider Network Management and Payer Innovation / Population Health initiatives. 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 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.
Nalini is a member of ACG’s Data Audit and Compliance Solutions teams. She brings clients over 11 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.
Elizabeth serves as a audit quality specialist in ACG’s Data Audit Group and supports clients on consulting engagements related to Medicare Advantage and Part D enrollment, reconciliation and premium billing operations, where she provides guidance on business process design and process controls and oversight and monitoring.
Prior to joining ACG, Elizabeth held roles such as Manager Enrollment and Premium Billing with AvMed Health Plans, Manager of A/R with CompBenefits and Finance Administrator with PNR Developers
Jon is a seasoned executive guiding risk adjustment programs for Medicare Advantage, ACA /Marketplace and Medicaid programs. He brings expertise in development and implementation of effective prospective and retrospective risk adjustment initiatives, appropriately targeted to maximize ROI. He is deeply skilled at guiding and developing analytics to identify/suspect potential risk adjustment opportunities, as well as monitoring for inappropriately coded claims and diagnoses to ensure accuracy in risk adjustment submissions to the MA Encounter Data Processing Systems and ACA Edge Servers. Jon has guided numerous organizations to develop effective controls to reduce data leakage and to manage submission errors.
Prior to joining ACG, Jon served as director of risk adjustment for a multi-state regional health plan that offered ACA /MA and Medicaid products, as well as serving as regional manager for risk adjustment at a national health plan.
Mr. Gamboa has more than 15 years of experience in healthcare management With a unique blend of expertise in healthcare data management, claims process/auditing and a a passion for process improvement, he is a well-rounded claims operations consultant.
Mr. Gamboa started his career in the mail room and moved through multiple departments to gain a full understanding of healthcare operations. From data analysis to provider and member satisfaction, Mr. Gamboa strives to make meaningful and impactful changes through his analysis and work. His background as a seasoned claims auditor, senior business analyst and project manager uplifts every team he joins.
Ms. Hicks has nearly 40 years of experience in guiding information technology and health plan operations departments and projects for insurance, managed care and state departments including major operations and IT centers. She has guided implementation and restructuring projects for national and local insurance, managed-care organizations, and public healthcare delivery systems.
Ms. Hicks has held numerous chief information officer roles with organizations including Santa Clara Family for Health, Central California Alliance for Health, LA Care (800,000 member Medicaid plan in California), FirstCare, TX, New West Health Services, Montana, along with operations and IT roles with companies including Peak Health, United Healthcare, Lincoln National, and QualMed.
She has worked as a contractor in support of CMS auditing efforts for Medicare Data Validation Audits in numerous large health plans throughout the United States.
Alan is a senior Project Manager with over 26 years of experience serving in lead project management roles for large scale systems and operations implementations, engagements with specialization in Medicaid MMIS system implementation and operations, along with 9 years of experience in Medicare health plan, start-up and operations. Alan advises and guides ACG client engagements in IT, operations and business development engagements managing project teams, project management, task identification to assure execution of the clients objectives. He also consults on health plan operations build and re-engineering. Prior to joining ATTAC Consulting Group, Alan served as Chief Operating Officer at Ally Align a multi-state MA plans as well as Senior Vice President and CIO for Government Healthcare Solutions at Xerox / ACS.
Ms. Hagen brings more than 30 years of expertise to clients in the health insurance and managed care industries. She is a senior consultant with experience in systems, operations, management and implementations. She has assisted states and health plans in procurement, analysis, monitoring and independent verification and validation. Hagen has expertise in business process mapping and re-engineering and developing cohesive teams through hands-on management.
Over her career, Ms. Hagen has held senior positions in operations and IT, and consulting roles United Health Care, Mercer Consulting, Health Services Advisory Group and Affiliated Computer Services Corp.
Ms. Lyons has more than 25 years of experience in project management supporting healthcare organizations and vendors to implement and upgrade information systems and business process. She has a proven ability to deliver quality results in complex organizational environments while fostering effective relationships with management teams and end users. She has been particularly successful at managing complex projects focused on key strategic and operational goals.
Jeff bring clients over 25 years of experience with implementation and operations of information technology platforms, including evaluation, selection, implementation and operation of core transaction systems, including enrollment and claims platforms with expertise in most major transaction systems in operation today. Jeff is also deeply experienced in data management including data migration between platforms along with design and implementation of system interfaces and data exchange processes. Jeff previously worked for Perot Systems and The Pace Group
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).
Megan supports ACG operations, IT and data management engagements, bringing clients 13 years of experience as a business analyst, configuration support analyst, and work team lead in documentation of business requirements, process and data work flows to support configuration of various systems. She also brings strong data analytic skills along with work plan development and project management experience to engagement teams. Prior to joining ATTAC Consulting Group, Megan held roles at LA Care Health Plan, FlexTech, Inc., SynerMed, Inc. and Arcadian Management Services Inc.
Mr. Vakhovskiy has more than 11 years of experience providing information technology and business process support to the healthcare and financial services industries. He has managed deliverables to support the development and implementation of complex product upgrades, enhancements and new market offerings. He built a managed care platform for home health care services, and managed integrations with Salesforce, Maestro, HRCM, and JIVA Managed care platforms for various payers. He has a track record of successful project delivery on time and within budget. He is proficient in Waterfall, RUP, SCRUM and Agile methodologies. Mr. Vakhovskiy has a strong knowledge of healthcare standards including HIPAA 4010, 5010, ICD-9 and ICD-10, as well as eligibility/benefits and claims processing models and EDI standards for claims processing (837, 835, 270/271, 834), Authorization (278) and enrollment (820).
Ms. Pahwa has more than 15 years of experience driving business and information technology transformations to successfully advance healthcare and pharmaceutical industries. She has focused on establishing a culture of collaboration and transparency, managed implementations of complex, heavy cross-dependency ground-up systems, upgrades and enhancements, and held high-visibility positions. Ms. Pahwa provides independent, expert and general program management support to multi-disciplinary and interdepartmental teams, and guide clients through operational and technology initiatives. She has served as the primary liaison for individual departments and entire organizations to support effective and sustainable practices to a wide range of audiences. She has supported writing and updating SOPs and implemented interoperability and training customer service departments for a health plan’s implementation of Medicaid. She is proficient in Waterfall, RUP, SCRUM, SAFe and Agile methodologies. Ms. Pahwa has a strong knowledge of Medicaid, Medicare, ACOs, MCOs and healthcare standards including ACA, price transparency, interoperability, HIPAA 5010, ICD-10, as well as claims and EDI standards (837, 835, 820, 270/271, 834).
Ms. Hardisty has more than 20 years of experience in commercial, Medicaid, and Medicare managed care operations and compliance, where she developed organizational solutions to ensure operational compliance while meeting internal and external stakeholder needs. Ms. Hardisty has developed and led multi-disciplinary teams spanning operations, compliance, and technology across a broad spectrum of managed care operations. Her work has included utilization management, care coordination, case management, disease management, appeals, grievances, credentialing, and call center operations. She is a strategic problem-solver adept at bringing stakeholders together to solve complex problems while identifying and evaluating problem and solution impacts, developing and implementing holistic solutions, and strengthening relationships.
Cathy McClain Gordon brings ACG clients more than 20 years of experience with Commercial programs, including Commercial / Marketplace, 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 aided clients launch 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 various MAOs, Management Service Organizations (MSO) and commercial insurers focused on 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.
Robert Spadaccini is an executive with 32 years of experience in government health and human services, health care and managed care program operations with a successful history of achieving positive results. He has experience working with legislative bodies and senior level executives in the public and private sectors. His responsibilities have included development and management of program budgets, Medicaid operations and implementations for new or expanding programs and reporting. He has a demonstrated history of producing results through building relationships, evaluating impacts of legislation, and managing change for a variety of projects and programs. In addition to strong leadership skills, he has hands- on experience with a wide variety of health plan operations including enrollment, claims, audit and regulatory operations/compliance.
Eric has more than 30 years of experience in leading ATTAC’s data analytics group. He is adept in design and development of application front-end and back-end solutions to support numerous business needs. Eric is an experienced data technician and architect of database systems to support analytics and production applications. He is deeply experienced in ACA risk model, CMS Medicare universes and other data models used in government healthcare programs.
Prior to joining ATTAC Consulting Group, Eric service as chief security officer for Referral MD, at CRM Solutions, d for AeroSoft, and senior project engineer for
Ms. Regalado has more than 25 years of healthcare experience with comprehensive knowledge of compliance regulations related to federal and various state Medicaid and commercial requirements. She has extensive experience in health plan operations, including claims management, claims auditing, system configuration, business process design, and workflow development. She excels at the ability to analyze processes for improvement and execute changes needed in a timely and efficient manner. Ms. Regalado has broad experience in healthcare claims functions.