With the launch of Segal Medicare Experts (SME), Shelley has brought together a strong and growing team of some of the sharpest minds in the healthcare industry. She works closely with her team to offer insight on integrated custom-tailored solutions to address challenges and deliver real-world solutions to Medicare Advantage Organizations (MAOs).
Shelley Segal, Founder and CEO, is a seasoned executive with more than three decades of experience in the Medicare managed care industry. Shelley is an accomplished collaborator with the unique ability to listen and understand the dynamics of all industry aspects. Shelley’s extensive compliance, operational and financial expertise provides clients the insight necessary to achieve better bottom-line results.
Segal is a nationally recognized compliance, regulation and training expert in the managed care industry, with expertise to include:
- MAOs and Part D day-to-day operational management
- Interpretation and implementation of Medicare regulations
- Creation and implementation of compliance and functional area training programs
- Implementation of operational best practices across multi-site organizations
- Guidance prior to, during and after the Center for Medicare and Medicaid Services (CMS) program audit
- Project management and facilitation of interdisciplinary project teams
- Providing subject matter experts for our client’s specific needs
As an industry recognized keynote speaker, Shelley regularly presents at key conferences to include, Industry Collaboration Effort (ICE), Health Care Compliance Association (HCCA) and Resource Initiative & Society for Education (RISE).
WHAT OUR CLIENTS SAY ABOUT SME
“Working with Shelley and her team at SME is an amazing experience. I was starting a new company from scratch and Shelley took the time to help me set up an in-depth compliance program for me and my entire team. She walked me through the entire process, and made sure that I understood what each document was and why it was important. She kept me in the loop from the beginning of the process until the very end. She made it easy for me!”
“I have known Shelley for the past 30+ years, beginning when she was part of my operations and executive team. With her knowledge and expertise in both the regulatory and health plan perspectives, Shelley provides her clients with effective and thoughtful solutions to some of the most complex Medicare Advantage issues facing the industry. I have engaged Shelley and her team on many projects, and my staff greatly appreciate their insights, actionable recommendations and rolling up their sleeves to make things happen I look forward to continuing to work with Segal Medicare Experts in the future! They are really the subject matter experts.”
“At my previous employer Brand New Day Health Plan, I used the assistance and auditing experience of Shelley and her team for over 10 years. The Plan selected them year after year to help with audits and projects because the SME team are experts who are timely, professional, flexible, and very helpful in preparing for CMS audits. We liked that they enabled us to learn to meet CMS standards and protocol by helping us to identify where adjustments were needed. SME not only pointed out our weaknesses, but provided us with advice regarding steps we could take to meet our goal of 100% compliance. A big “plus” is that Segal Medicare Experts responds quickly with citations and clarifications, and we could always count on them!”
“Shelley and her team are meticulous and well-versed in the Medicare Managed Care industry. I can count on her for timely and accurate results to help navigate complex issues in a variety of areas. She is always there when needed and goes above and beyond to deliver exceptional support and results.”
Having a difficult time getting started with your CPE Audit?
Let Segal Medicare Experts help you to surpass any obstacles.
SME has a comprehensive team of CMS Program Audit experts, including SME leaders who previously worked at CMS and have first-hand experience conducting CMS Program Audits.
Additionally, SME respects and appreciates how important it is for MAOs, PDPs, and MMPs to be front and center with CMS, leading their performance during a Program Audit. This is why SME uses a behind-the-scenes approach, which provides you with full audit support, including:
✓ Clarification of audit requirements throughout the audit process
✓ Review of documentation, including data universes, prior to submission, during fieldwork, and if needed, throughout validation and close out
✓ Training associates and FDRs on strong audit performance skills
✓ Best practices in conducting and leading tracer reviews
✓ Assistance with technology and facility set up to ensure a smooth audit experience, including connectivity with your FDRs
✓ Taking notes and tracking deliverables throughout fieldwork
✓ Guidance for and review of any corrective action required as a result of the audit
✓ Drafting communications to keep FDRs, leadership, employees, and key stakeholders informed of the audit process and outcomes.
Regardless of your current state of audit readiness, adding Segal Medicare Experts to your CMS Program Audit team provides your organization and associates with additional assurance by an expert professional team to conduct your annual CPE audit.
SME will help you prepare documents in advance, to avoid that last-minute scramble after you receive a CMS audit notice.
Our experts are standing by to help.
Call us or write to us today. Office: 562.334.7980