ATTAC Consulting Group’s Leadership and Consulting Team

Marcia has more than 30 years of experience and leadership and management of clinical and quality programs for Medicaid and Medicare Advantage programs and commercial products.  She has deep expertise in the design, implementation and oversight of delegated medical management program models, including development of provider incentive and monitoring programs focused on effective and compliant medical management.    Marcia also has deep expertise in evaluation of HEDIS quality data and designing of interventions targeted at addressing quality and population health initiatives.     Among the many senior executive roles Maria held over her career, she served as Vice President for Medical Management with Inland Empire Health Plan (CA.)

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

Alan is a senior project manager with more than 26 years of experience in project management for large-scale systems and operations implementations, and engagements with specialization in Medicaid MMIS system implementation and operations. He has nearly a decade of experience in Medicare health plan, start-up and operations. Alan advises and guides client engagements in IT, operations and business development. He manages project teams, project management and task identification to ensure execution of each client’s objectives. Alan 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 plan, and as SVP and CIO for Government Healthcare Solutions at Xerox / ACS.

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.

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).

Rich is an expert in encounter submissions and risk adjustment efforts. He has managed encounter submission and risk adjustment analytics teams across Medicare Advantage, ACA and Medicaid programs, along with risk adjustment operations and RADV for the ACA Marketplace.

He has designed, deployed, analyzed, and refined prospective and retrospective programs. Rich draws on his extensive experience with data for continuous improvement and optimization of risk adjustment efforts, aimed at maximizing ROI and minimizing costs.

Rich has also served as an encounter (EDPS/Medicaid) and Edge Server platform product-owner, managing requested or required changes to software.

Prior to working in the healthcare industry, he spent 15 years using advanced quantitative analytics to improve customer loyalty and retention across banking, market research and database marketing agencies.

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 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.

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, COO /VP of application development at CRM Solutions, director of applications for AeroSoft, and senior project engineer for CFD Research Corporation. 

Tina is Provider Network Contracting leader with 25+ years’ experience building Medicare, Medicaid and Marketplace networks and applying value based payment models.   She also has 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 Contracting, 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

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.

Mr. Giles has more than 30 years of experience provider reimbursement, risk based contracting and value based payment models.   He works with health plans, physician groups, IPAs, medical groups and hospitals. He has extensive experience in market and product development, healthcare reimbursement and financing, development, and management of large-scale provider networks. David has worked with commercial, Medicare, Medicaid, and dual-eligible health plans and their contracted providers on the design and implementation of value and risk-based reimbursement, and in setting up data analytics to evaluate and monitor success.

In addition to designing and developing provider networks throughout the US, David has broad experience assisting clients in developing provider networks and meeting regulatory requirements for Medicare, Medicaid, and employer group plans. This includes analysis of provider access and adequacy compliance and the related regulatory filings.

Prior to joining ATTAC Consulting Group, Mr. Giles held senior management roles at BCBS, Carolina Medical Care, Humana Health Plans and as a consultant throughout the United States. He is a graduate of the University of Pennsylvania.

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. 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.

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.

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.

Mr. Janicek has more than 25 years of healthcare experience overseeing operations and workforce management departments that support Medicare, Medicaid, commercial and pharmacy product lines. Throughout his career, he has completed cross-segment transformation projects and continuous improvement initiatives that require problem solving, relationship building, influencing and analyzing data. He has driven business organization, administration, and operational management initiatives through strategic policy and procedure development and implementation in line with corporate strategic goals. He is adept at vendor management experience with proposals, implementation and oversight, and has extensive experience reimagining call centers for inbound, outbound, omni-channel and back-office functions.

Helene is a member of ACG’s Clinical Management and Compliance Teams. Helene brings to clients expertise in implementing clinical and quality operations for Medicaid, Medicare Advantage and Dual programs, Special Needs Plans and commercial health plans.   She is a specialist in SNP Model of Care design and implementation, 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).

Lynn has 30 years of experience leading clinical operations for utilization management, case management, quality improvement, HEDIS measurement and risk adjustment.  Lynn has developed Medicaid,  Medicare, Marketplace and commercial programs focused on addressing population-health needs.   She has extensive experience working with healthcare delivery systems and is a master’s prepared nurse.  Her leadership experience includes inpatient, ambulatory and health plan environments.

Lynn has built and supported various community access-to-care initiatives. She has developed and implemented Social Determinants of Health programs and has worked across membership populations. Given her work in various community care initiatives, she understands the struggle of diverse populations and the importance of delivering quality care while balancing cost efficiency.

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 provides legal, regulatory and compliance in clinical services for commercial and  Medicaid specialty in serious mental illness, comprehensive long-term care and children’s medical services.  Mia is a specialist in the Mental Health Parity and Addiction Equity Act and development of NQTL comparative analyses.

Prior to joining ACG, Mia served as senior compliance specialist for Centene and regulatory compliance and quality specialist for Bayfront Health (FL) and HealtheSytems.

Paul Lake is a healthcare program and project leader with more than 25 years of experience in the industry. He has directed digital transformation implementations and multiple solutions for health plans with Medicaid, Medicare and commercial core systems. He has also led provider-focused revenue cycle management solution implementations.

Paul steered multiple Program Management Office (PMO) initiatives in the payer and provider environments, including direct accountability for quality assurance deliverables.

Prior to joining ATTAC Consulting Group, Paul held senior leadership roles at Optum360, Xerox/ACS, and Dell/Perot Systems

Kim serves as an audit project coordinator within the Data Audit Group. She supports project management, day-to-day audit operations, and quality assurance activities for government-mandated risk adjustment and data validation audits. Prior to joining ATTAC Consulting Group, Kim served in project management and client relations roles for various organizations.

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.

Ashleigh is the practice leader for ATTAC’s Provider Network Operations Team, supporting plans operating Medicare, Medicaid and Commercial products.  She guides plans in developing processes to manage provider data and drive uniformity, efficiency and consistency in provider relations, provider data management, network analysis and credentialing. Ashleigh has a strong background in provider contracting. She 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 ATTAC.

Cathy McClain Gordon brings ATTAC’s clients more than 20 years of experience with commercial programs, including marketplace and government-sponsored programs (Medicare Advantage, Medicaid and TRICARE). She has 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.

Cathy has helped clients launch new lines of business and manage financial risk arrangements by developing and deploying successful risk adjustment strategies. She has helped prepare for delegation oversight and monitoring, developed care coordination models, executed provider network incentive models, and employed quality improvement strategies to meet CMS 5-Star, HEDIS, State and health plan quality measures.

Prior to joining ATTAC, Cathy worked for various MAOs, MSOs and commercial insurers. Her focus areas included process improvement, 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.

Katie serves as an audit coordinator within the Data Audit Group. She supports project management, day-to-day audit operations, and quality assurance activities for government-mandated risk adjustment and data validation audits. Prior to joining ATTAC Consulting Group, Katie served in senior project management and customer service roles for various organizations.

Ms. Mercer has broad expertise in Medicare Part C/D and commercial appeals and grievance. She has 13 years of Medicare experience in process improvement, audit/monitoring and enrollment operations. Ms. Mercer’s experiences includes implementing operational and technological best practices to ensure quality and compliance with organizational, state and national standards. She has served in senior roles with HealthSpan Integrated Care, CVS Caremark Corporation, Smart Insurance Co. and Universal American

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.

Sheila is a member of ACG’s Clinical Management team, specializing in managed Medicaid, Medicare and Duals programs, Special Needs Plans (SNP) clinical operations.  She has extensive expertise in federal and state regulations, risk management and CMS Stars, HEDIS and HOS measures and intervention design. 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.

Nancy Mundy, RN, is a compliance expert with nearly 30 years of experience, with specialties in Medicaid and Medicare, and Commercial compliance and plan operations.  As a compliance and privacy officer, she has served on multiple executive leadership teams. Her expertise includes compliance program design and implementation, risk assessment/management and audit plan creations, key indicator report development, root-cause analysis, corrective and preventive action plan formations, ethics, third-party delegate oversight, investigations, material filings with regulators, regulator inquiries/complaints, regulatory guidance interpretation and implementation oversight, fostering regulatory relationships, governing body reporting, program integrity, and leading external audits. She has experience crosses multiple product types including Medicaid, Medicare Advantage, Medicare Part D, commercial, FEHB, and ASO self-funded arrangements. Nancy is a member of the HealthCare Compliance Association and certified in Healthcare Compliance.

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

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).

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

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.

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.

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. 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).