Melissa Bailey is a Senior Consultant at Gorman Health Group (GHG). In this role, she offers our clients assistance and leadership in executing compliance activities while providing insight on regulatory requirements and industry best practices. Melissa brings GHG more than 15 years of healthcare experience.
Prior to joining GHG, Melissa worked for some of the nation’s leading insurers. She developed a diverse background in operations by holding positions in Member Services, Appeals and Grievances, Sales, and Provider Network. Melissa leveraged this experience when she moved into the Compliance arena, conducting plan-wide audit and oversight activities by performing risk assessments, developing performance monitoring processes, and overseeing successful Centers for Medicare & Medicaid Services (CMS) program audits and corrective action plan remediation. Melissa then began managing the day-to-day operations of the Compliance Department, investigating compliance, Health Insurance Portability and Accountability Act (HIPAA), and Fraud, Waste, and Abuse (FWA) incidents, and ensuring compliance program effectiveness. Melissa has particular experience with the Medicare and Medicaid dual-eligible population, having spent a number of years at a Dual Eligible Special Needs Plan (D-SNP), and led the implementation of the Medicare-Medicaid dual demonstration in six states.
As a consultant for GHG, Melissa offers her subject matter expertise for activities including, but not limited to, conducting mock audits and readiness assessments, preparing plans for CMS program audits, reviewing marketing materials, providing regulatory interpretation, and serving in interim management staffing roles.