Meeshaun Beattie

Director of Compliance for an agency provided services for Community HealthChoices (CHC) waiver program participants— which is part of the Home and Community-Based Services (HCBS) Medicaid waiver administered by the Office of Long-Term Living (OLTL) — has a dual role: ensuring the agency meets all applicable federal, state, and waiver-specific requirements while maintaining a culture of accountability and risk prevention.

Monitor and enforce compliance with:

• Pennsylvania Chapter 52 & 62 regulations and CHC waiver-specific requirements, including service authorization conditions, contract obligations, and managed care rules
• Track and interpret regulatory updates from OLTL, CMS, and other oversight bodies to ensure alignment with current lawReview agency policies, procedures, forms, and operational practices for compliance with all applicable statutes and regulations
• Review agency policies, procedures, forms, and operational practices for compliance with all applicable statutes and regulations
• Support regulatory readiness for audits, inspections, and surveys

Conduct or coordinate internal audits of:

• Individual records, clinical and medication administration records (MARs).
• Staff training, incident follow-up, and complaint/grievance documentation.
• Site reviews and quality assurance activities
• Develop and deliver compliance training for leadership, clinical staff, and direct support professionals on legal, ethical, and regulatory standards
• Identify, assess, and mitigate compliance risks across programs and services
• Serve as a liaison between legal, quality improvement, risk management, and operational teams to ensure alignment

Audited and analyzed the quality and efficiency of services delivered by providers in the entire state of Pennsylvania in OLTL waivers and the Community HealthChoices (CHC) Managed Care Program.

Conducted on-site and remote audits of OLTL waiver and CHC providers to assess adherence to regulatory and program standards.

Reviewed service quality, efficiency, and compliance across six CMS quality assurances: Level of Care, Qualified Providers, Service Plan, Health & Welfare, Financial Accountability, and Administrative Authority.

Apply a discovery/ remediation/ improvement cycle to address non-compliance, fix issues for individuals and prevent recurrence.

Prepared reports and recommendations for OLTL leadership and oversight bodies, facilitating informed decision-making.

Ensures authorizations, faxes and communications with service vendors are processed accurately and timely. Ensures supplies from various vendors and service providers are ordered correctly. Oversees documentation related to Member Acknowledgement letters, NOS (Notice of Actions), Change in Service and Approval of ongoing and/or new services. Guided Service Coordinators in resolving claims and ensuring authorization accuracy. Managed relevant care coordination reports for skilled and non-skilled services by delivering them to Service Coordinators. Educated Service Coordinators on plan benefit information, enhancing their ability to assist members and providers.iders. Participates in team and performance improvement projects. Provides guidance, expertise and training to other Service Coordinators whom may not have similar experience. General duties to include answering the phone, providing good customer service to the members, providers and the IDT.

• Developed and implemented care plans tailored to individual client needs.
• Coordinated training programs for care staff to enhance service delivery.
• Monitored compliance with regulatory standards and best practices in homecare.

May 2016- Sept 2017

Supervise front-line staff that take inbound calls from physically disabled Pennsylvania residents that have and/or qualify for Medical Assistance to apply for in-home care services. Oversaw customer service employees, maintained quality standards, met deadlines, and followed proper procedures while correcting errors or problems.

Participated in meetings and recommended changes to policies and procedures. Support and enforce contact center expectations Handle all escalated calls from attorney and state legislative offices Living, Area Agency on Aging, County Assistance Offices, and Service Coordination Agencies).

Develop work schedules and assign duties to direct report personnel to ensure efficiency. Interview, Hire, Re-train, and terminate employees. Trained and provided support to new Call Center in Chicago, IL.Point person for Vice President and Support Mailbox for researching and responding to high priority cases from client and state agencies (Office of Long Term Living).

Oct 2017 - Feb 2020

Management responsibilities included overseeing supervisors, team leads, office staff, and field staff. Ensured that escalated cases for disabled Pennsylvania residents applying for HCBS/CHC waiver services, that currently have or have applied for Medicaid benefits, were handled within the contractually agreed upon time frame. Direct liaison for the project to the clients. Clients included OLTL (Office of Long Term Living), CAO (County Assistance Offices), AAA (Area Agency on Aging), DOH (Department of Human Services), and attorney offices. Wrote, approved, and implemented work processes and procedures across the entire project. Included in all hiring and promotions for all entry level and mid-level employees

Processed Medicare Part B provider applications and credential provider reassignment requests by verifying submitted information.

Enhanced provider information for accuracy and compliance.

enrollment records contained in Provider Enrollment Chain & Ownership System(PECOS)

Supervise daily activities and delegate workflow tasks for call center representatives. Lead Supervisor for Medicare services department of 100 customer service representatives. Contributed to the hiring, training, and termination processes for employees. Scheduling representatives weekly and daily schedules for all call center representatives.

Managed an internal specialized CORE services department of 12 representatives making all outbound calls to members. Handle all escalated grievances from members with denied prescription claims and enrollments/disenrollments. Maintain inventory for all returned mail and general correspondence. Managed administrative tasks for call center CORE services manager, ensuring quality assurance of outgoing correspondence, scheduling department meetings, and maintaining workflow.

• Oversaw daily operations, ensuring compliance with regulatory standards and company policies.
• Streamlined workflows to enhance efficiency and reduce processing times for team tasks.
• Mentored staff on best practices, fostering a collaborative and high-performance work environment.

Processed Medicare applications for licensed agents to sell Medicare Part A, B, C, and D policies, ensuring compliance. inbound/outbound calls to gather additional and missing information on submitted applications, enhancing application accuracy.information. Coordinated with Medicare companies to ensure timely completion of application processing from submission to licensing.h Medicare companies to complete application processing from start to finish. Obtain permissions from different states' insurance commissioners to license agents to sell products

• Developed and maintained strong relationships with insurance agents to enhance service delivery.
• Assisted in coordinating training sessions for new agents on product offerings and compliance regulations.
• Analyzed client needs to recommend appropriate insurance products, increasing customer satisfaction.

• Relevant Coursework: Install & Troubleshoot

• Awarded Naval Airman of the year
• Relevant Coursework: Aviation Air Traffic Control
• 4.0 GPA
• Ranked in Top 1% of class

• 3.8 GPA
• Honor Roll Junior & Senior year