Senior Consultant, Healthcare Analytics & Risk Adjustment Solutions
Debra Faulkner is a Senior Consultant of Healthcare Analytics and Risk Adjustment Solutions at Gorman Health Group, LLC (GHG). In this role, she is responsible for the development of new product solutions, operational efficiencies, and applications that span across multiple domains within Medicare and Medicaid. She has been working with one of the industry’s healthcare leaders of population health on development, implementation, and interface between new applications in the areas of government compliance and utilization management.
Debra brings GHG clients more than 25 years of experience in commercial, Medicare, and Medicaid health plans and provider operations. In addition, her strong background with system applications and knowledge bridges the gap between healthcare providers, plans, and regulatory agencies. Additionally, she has experience in developing strategies, initiatives, and end-to-end applications that support operations and integration of data, analytics, and policy across the healthcare and delivery ecosystem.
Prior to joining GHG, Debra led large health plan operations, participated in the Centers for Medicare & Medicaid Services (CMS) fraud, waste, and abuse efforts, and developed and integrated healthcare applications that created operational efficiencies and compliance within the complex, highly regulated healthcare environment. She has also led cross-functional teams to include onshore and offshore operational and system development. Debra has a strong knowledge of risk adjustment, is proficient in multiple system applications, and is a strong leader in commercial and government regulations and regulatory requirements.
Furthermore, Debra also brings strong experience in developing and operationalizing data governance, cost share reduction operations, regulatory compliance, and vendor management. For the past decade, she has been focused on federal and state interactions in the context of ongoing operational requirements and effects on health plan operations and care delivery.
Debra received her Bachelor of Science and Master’s degree in Health Care Operations from St. Leo University in Florida.