MCS co-founder Julie Mason began her Medicare career more than twenty-five years ago when she joined the Centers for Medicare and Medicaid Services (then HCFA, the Health Care Financing Administration) in the Washington, D.C. office. In 1992, she joined CMS’s San Francisco Regional Office, where she spent the next 16 years as a leader in the Medicare managed care division. Julie has developed extensive knowledge of complex Medicare managed care laws, regulations, and policy guidance, applying it to monitor and audit numerous Medicare health plans. She has conducted dozens of CMS audits and new Medicare Advantage application reviews.
A respected expert in the region, Julie was appointed as the San Francisco representative to many national CMS workgroups, and received numerous CMS and DHHS awards. Julie left public service in 2008 and joined a Medicare consulting practice as a lead compliance expert. Her facility with the heavily regulated Medicare Advantage program and her insider understanding of the CMS mindset is invaluable to clients attempting to navigate the complexities of the Medicare Advantage program. As a consultant, Julie provides the following expertise to clients:
- Coaching MA and PDPs through their CMS audits.
- Creation of effective corrective action plans.
- Successfully appealing CMS’s denial of applications.
- Evaluating sales and marketing activities for compliance.
- Conducting compliance risk assessments.
- Preparing applications for new Medicare managed care applicants.
- Developing and implementing policies and procedures.
MCS co-founder Shelley Segal is a Medicare Advantage industry veteran whose experience in Medicare program leadership and day-to-day operations provides our clients with an expert resource for strategic planning, program development, compliance management and business process engineering.
Prior to co-founding Medicare Compliance Solutions, Shelley was with a Medicare consulting firm for 10 years, where she served as Chief Operations Officer. Prior to that, she worked at several health plans for over 15 years and was the Compliance Director for SCAN Health Plan, an HMO serving over 100,000 Medicare beneficiaries in the Southern California market.
Shelley also served as the National Director of Medicare Compliance and Vice President for Medicare Operations at Health Net, and held numerous positions with Medicare programs at Foundation Health.
Shelley is a nationally recognized compliance and regulation expert in the managed care industry, with expertise:
- Medicare Advantage and Part D day-to-day operational management (Call center, appeals, grievances, enrollment, sales/marketing).
- Interpretation and implementation of Medicare regulations.
- Creation and implementation of compliance and functional area training programs.
- Implementation of operational best practices across multi-site organizations.
- Guidance prior to, during and after the CMS performance audit.
- Project management and facilitation of interdisciplinary project teams.