Phone:

+ 1 570-842-8144

Barbara Ann Holmes, Certified Mediator

Healthcare Leader | Principal Consultant

Mrs. Holmes is an accomplished senior leader with extensive experience in Medicare and Medicaid Managed Care industry; she is experienced in working with both start-up organizations and well-established health plans. Her many years of prior experience working in senior leadership roles has enabled her to effectively develop new operational models and enhance existing models to improve overall operations and adherence to compliance requirements.

Barbara is highly respected in the healthcare industry and is recognized as a genuine and collaborative leader who gains tremendous satisfaction in sharing her knowledge and mentoring her teams to act with awareness, compassion and integrity.

She is well known for her many years of practical experience which enables her to quickly assess the landscape, identify potential risks and issues, and promptly craft mitigation strategies and resolutions that strengthen the overall managed care operating model.

Mrs. Holmes works closely with the clients and her teams to fully understand work processes and operational activities so that they can be validated to ensure they are in compliance with Federal and State regulatory requirements as well as with health plan standards and best practices.

Barbara is extremely capable in visualizing both the big picture and the detail supporting it and can seamlessly transition between strategic and operational initiatives to effectuate change and achieve business objectives.

Mrs. Holmes is a certified mediator and has earned both a Bachelor’s degree in Applied Arts and Sciences, and a Master’s degree in Public Administration from Texas State University.

Key Capabilities

  • Operational Compliance
  • State & Federal Audit Preparation
  • State & Federal Audit Remediation
  • Policies and Procedures
  • Market Exits
  • ­Regulatory Compliance
  • Medicaid
  • Medicare Advantage (MA)
  • Special Needs Plans (SNP)
  • Medicare-Medicaid Plans (MMP)
  • ­Sales/Marketing Oversight
  • Model of Care
  • Medicare Part D
  • Plan Start-Up
  • Fully-Integrated Specials Needs Plans

Operational Compliance – Medicare-Medicaid Plan (MMP)

  • Executive leadership experience includes implementing Medicare-Medicaid (MMP) markets for VA, TX, CA, and NY. Plans implemented met all requirements in the MMP 3-Way Contracts for Medicare Advantage and Medicaid.
  • Provided clear direction and leadership to multiple operational areas for multi-state Medicare- Medicaid (MMP) that met or exceeded business objectives.
  • Team lead for three state MMP Audits and one CMS MMP Program Audit simultaneously resulting in positive outcomes.
  • Successfully implemented the Virginia Medicare-Medicaid Plan (MMP)/Commonwealth Coordinated Care (CCC) Plan for a Medicaid only Health Plan which resulted in a deficiency-free readiness review evaluation from CMS and the State.

Medicare Advantage - Part D

  • Partnered with business to implement new requirements and facilitate resolution of ongoing Medicare Part-D questions and issues.
  • Ensured that Part D Pharmacy Operations for all health plans (MA-PD/DSNP/MMP) met CMS regulatory requirements.

Medicare Advantage

  • Restructured compliance management of a Fully Integrated Dual Eligible Special Needs Plan (FIDE SNP).
  • Re-engineered operational processes in a Medicare Advantage Enrollment Department resulting in elimination of notices of non-compliance.
  • Implemented seven new Dual Eligible Special Needs Plans (DSNP).
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Contact us

107 Red Shale Road
Elmhurst Township, PA 18444

USA

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Business Time

Monday - Friday
9:00 am - 5:00 pm

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Appointment

Call to discuss how we can
help you achieve your goals!

Phone: +1 570-842-8144