Sandy Miller is a Senior Consultant at Gorman Health Group (GHG). Sandy brings GHG clients more than 15 years of Medicare and Medicaid compliance, regulatory affairs, and operations experience.
Sandy’s core competencies include compliance program development and oversight, risk management, monitoring and auditing, policy and procedure (P&P) development, regulatory affairs, product implementation, Pharmacy Benefit Manager (PBM) operations, and Centers for Medicare and Medicaid Services (CMS) audit preparation. Sandy is known for her ability to establish collaborative relationships, manage teams, and provide education and training regiments. Sandy’s proven track record, strategic thinking, strong communication and analytical skills, and commitment to integrity and accountability allow for her to establish operational best practices and drive problem resolution while promoting compliance with applicable regulations.
Prior to joining GHG, Sandy worked for health plans and a PBM where she served in multiple Compliance and Regulatory Affairs roles with responsibility for creation and implementation of compliance programs, delegation oversight, risk assessments, monitoring and auditing, and creation of P&Ps. She has held the role of Medicare Compliance Officer at a Blue Cross and Blue Shield Plan, with responsibility for the overarching Compliance and Regulatory Affairs program, which included building a delegation oversight work plan and chairing a Fraud, Waste & Abuse (FWA) committee, implementing the plan’s first formal Medicare Part D fraud program. Sandy has also managed multiple regulatory affairs teams, assuring appropriate operational implementation to promote compliance with federal and state laws, rules, and regulations.
Sandy has held roles with responsibility for Medicare plan applications/service area expansions and state Medicaid plan requests for proposal. She also has experience in facilitation of interdisciplinary teams for implementation and operation of Medicare/Medicaid products. Sandy is known for her expertise in Employer Group Waiver Plan (EGWP) regulations and, while working for UnitedHealthcare, worked with CMS staff to promote the health plan and employer group perspective with respect to EGWP requirements.
As a consultant for a PBM, Sandy was responsible for the creation, implementation, and oversight of a Compliance and Regulatory Affairs program while working with PBM staff to understand the implications of working in the Medicare environment. In this role, she created processes for regulatory, Healthcare Effectiveness Data and Information Set (HEDIS®), and National Committee for Quality Assurance (NCQA) analysis and implementation. She also created an end-to-end gaps assessment, which was used to create strategic work plans and capacity planning.