Strategic Medicare Compliance Program Manager

GERALINE SAVOIA, MBA

Compliance Program Manager/ Product Benefit Manager Medicare • Medicaid • Marketplace *********@*****.*** 360-***-**** Oroville, WA Remote Strategic compliance leader with 15+ years of experience designing and transforming risk assessment, monitoring, and audit frameworks across highly regulated healthcare and life sciences environments. Proven expertise in building data-driven compliance programs that proactively identify risk, detect fraud, and strengthen governance across enterprise operations. Recognized for modernizing compliance monitoring through analytics, automation, and cross-functional partnership with Legal, Audit, Finance, Medical, and Product teams. Deep knowledge of CMS, HIPAA, GDPR, and enterprise risk frameworks (NIST CSF), with a strong track record translating complex regulatory data into executive-level insights that drive business decisions and risk mitigation.

CORE COMPETENCIES

• Medicare & Medicare Advantage Compliance

• CMS Regulatory Affairs & Implementation

• Enterprise Risk Assessment & Mitigation (RAMP Design)

• Data-Driven Compliance Monitoring & Analytics

• Fraud, Waste & Abuse (FWA) Detection & Prevention

• Compliance Dashboards & Executive Reporting

• AI-Enabled Risk Identification (Conceptual & Applied)

• Audit & Monitoring Program Transformation

• Third-Party & Vendor Risk Management

• Regulatory Compliance (CMS, HIPAA, GDPR)

• Cross-Functional Governance & Stakeholder Influence

• Root Cause Analysis & Investigation Support

• Data Integrity, Traceability & Controls Governance PROFESSIONAL EXPERIENCE

Medicare Operations Compliance Program Manager Providence Health November 2023 – Present

• Lead enterprise compliance strategy for Medicare Advantage programs, designing and executing risk-based monitoring frameworks aligned with CMS and NIST CSF standards.

• Partner with cross-functional leaders (Legal, Product, Medical, Finance, Audit) to identify emerging compliance risks and implement proactive mitigation strategies across business units.

• Develop data-driven reporting and executive dashboards to track compliance performance, risk indicators, and control effectiveness, enabling leadership decision-making.

• Drive continuous monitoring initiatives by analyzing operational, regulatory, and vendor data to detect trends, control gaps, and FWA risk patterns.

• Serve as a primary compliance advisor in governance forums, influencing enterprise risk strategy and regulatory readiness.

• Coordinate with downstream entities and vendors to strengthen third-party compliance oversight, improving turnaround times and reducing risk exposure.

• Support investigations and high-risk initiatives, conducting root cause analysis and remediation planning for compliance issues.

Medicare Benefit Program & Compliance Manager Prior Role

• Designed and implemented 150+ compliant benefit plans while integrating risk assessment methodologies and regulatory controls across product development lifecycles.

• Interpreted complex regulatory changes (CMS, ACA, state regulations) and translated requirements into actionable compliance frameworks and monitoring controls.

• Collaborated with IT and operations teams to improve data quality, system controls, and compliance reporting accuracy. Corporate Compliance Manager – External Audit CareSource April 2020 – July 2023

• Led enterprise-wide compliance audit and monitoring programs across multiple markets, incorporating data analytics to identify risk trends, control gaps, and non-compliance patterns.

• Designed and enhanced risk assessment frameworks and compliance workplans, improving proactive risk detection and reducing exposure by 30%+.

• Built and delivered executive-level compliance reports and dashboards, translating complex datasets into actionable insights and strategic recommendations.

• Partnered with Internal Audit to support audit readiness, control testing, and remediation tracking, ensuring regulatory compliance and operational consistency.

• Oversaw third-party risk management, including vendor oversight, performance monitoring, and compliance adherence.

• Led FWA detection initiatives using data trend analysis, strengthening fraud prevention capabilities across the enterprise. Privacy Investigator Aetna September 2013 – April 2020

• Conducted enterprise-wide risk assessments and compliance investigations, analyzing privacy incidents and identifying systemic control weaknesses.

• Applied structured risk frameworks to detect fraud, privacy risks, and compliance violations across financial and healthcare programs.

• Developed and implemented data governance and privacy controls aligned with HIPAA, GDPR, and SOC 2 principles, ensuring data integrity and regulatory compliance.

• Delivered compliance insights and recommendations to leadership, supporting policy enhancements and operational improvements.

• Led compliance audits across claims, billing, vendor oversight, and training programs, ensuring adherence to federal and state regulations.

Senior Compliance Consultant Aetna

• Performed health plan compliance and integrity reviews — post-implementation, migration, and performance covering process documentation, training, claims review, PBM vendor oversight, and data integrity.

• Negotiated contracts and performance metrics with first tier and downstream vendors, achieving 15% cost savings while maintaining service level agreements.

• Coordinated with downstream entities to monitor and improve product quality, achieving a 98% end-user satisfaction rate.

• Planned and conducted billing/coding audits, policy/procedure audits, training audits, and FWA investigations; completed all required regulatory reporting accurately and on time.

• Maintained up-to-date knowledge of federal and state laws; interfaced with industry groups and regulators on compliance adherence and controls.

Program Administrator (Manager) State of Florida – Agency for Healthcare Administration August 2006 – September 2013

• Managed large-scale Medicaid program operations, implementing risk management and compliance oversight frameworks across state-regulated healthcare programs.

• Ensured regulatory adherence, program integrity, and stakeholder accountability through monitoring, reporting, and process improvement initiatives.

EDUCATION

Colorado Technical University

• Master of Business Administration (MBA)

• Bachelor of Science, Healthcare Management

• Associate of Science, Health Administration Services Technical Skills

• Experience modernizing compliance monitoring using data-driven insights

• Strong ability to translate regulatory and operational data into executive strategy

• Proven leadership in cross-functional, enterprise risk environments

• Deep expertise in fraud detection, audit readiness, and risk mitigation frameworks

• Exposure to emerging compliance risks (data privacy, digital processes, vendor risk)

Contact this candidate