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April Fleming brings to Gorman Health Group technical expertise and experience in Medicare compliance. April’s Medicare experience includes interpreting regulations, creating policies and procedures, and reviewing marketing materials to ensure compliance with CMS guidelines. While at GHG, she blends her Medicare experience with her technical expertise to simplify and streamline processes while improving efficiency within the managed care organization. She also utilizes this experience while assisting health plans to file their applications with CMS for approval, in addition to helping plans remain compliant with CMS by performing mock MA, MA-PDs, and PDP audits. Finally, she has conducted training for health plans and has developed educational modules for GHG’s Medicare Training Academy. April’s grasp of Medicare managed care rules and regulations enables her to develop tools that help streamline processes and improve efficiency. She has developed the GHG tools used in COMPASS audits and has created both marketing and appeals and grievance databases for use by health plans. Finally, April utilizes her Medicare expertise on GHG’s PDE reconciliation engagements that help reduce plans’ financial liability to CMS. Prior to joining GHG, April served in Compliance at SCAN Health Plan. While there, she conducted internal audits, marketing review, and internal on-line training for SCAN staff while also working with the plan’s PBP, in addition to helping build the intranet. She also worked on a number of application fillings, including service area expansions for a MA-PD and Dual Eligible SNP. April currently resides in Kansas City, Missouri. | 