Gloria Canfield

Gloria Canfield brings to Gorman Health Group (GHG) extensive knowledge in Medicare managed care compliance, with a focus on appeals and grievance rules and regulations. Since joining GHG Gloria has assisted plans become and remain compliant with CMS regulations and guidance. She has done this by assisting new Medicare Advantage plans prepare and submit their applications to CMS and implementing the Medicare Part D program when the program was just starting and now implements new MA-PD plans. Gloria helps Medicare plans remain compliant with CMS rules and regulations by conducting Mock CMS audits and  preparing health plans prepare for their upcoming audits by reviewing and updating policies and procedures, conducting mock interviews and reviewing case samples prior to the audit.

Prior to joining GHG, Gloria worked with CMS in the San Francisco Regional Office for ten years. Gloria was a Plan Manager in the Medicare Managed Care Division. As a Plan Manager Gloria:

• Served as a Plan Manager, regulator, for SCAN, Health Plan of Nevada, UHP, Maricopa, Contra Costa Health Plan, and Hometown Health Plan all Medicare Advantage health plans in Region IX.
• Conducted on-site monitoring for Medicare compliance, health services delivery, and quality assurance reviews of Medicare contracts, new Medicare Advantage applications, and service area expansions.
• Completed initial evaluations of applications and service area expansion.
• Acted as team leader on site visits to Medicare Advantage plans which involved supervising various staff members.
• Conducted on-going monitoring to assure plan compliance with Medicare contract requirements through analyses of systems and other available data.
• Monitored plan performance and progress through evaluation of corrective action plans and recommended enforcement action.
• Provided technical assistance and acted as a functional expert to Medicare Advantage Organizations, Medicare contractors, providers, State agencies, advocacy groups, and the Social Security Administration.

Gloria was also lead appeals and grievance expert for CMS San Francisco Region IX. She also served on national appeals and grievance workgroups that wrote the appeals and grievance chapters of the Medicare Managed Care Manual, and instituted and tested the Targeted Appeals Measurement System (TAMS) consequent to the Grijalva court order.

Prior to joining CMS, Gloria spent over 20 years working for the Social Security Administration in progressively responsible jobs such as operations supervisor, branch manager, and regional management analyst.

During the course of Gloria’s work for the federal government, Gloria received 23 monetary awards for special acts or service and for superior performance. She also received the Secretary of Health and Human Services Award for distinguished service.