Elaine Strader, B.S. CHC is a Senior Consultant at BluePeak Advisors (BPA) and has been in the Medicare managed care industry for more than 30 years. She advises health plans on regulatory, operational and compliance matters.
Prior to consulting, Elaine held a Chief Compliance Officer role in a regional Blue Cross Blue Shield Medicare Advantage plan. In this role, Elaine was accountable for maintaining an effective compliance program to prevent, detect and correct non-compliance and potential fraud, waste and abuse in accordance with CMS requirements. Elaine has extensive experience in the development of compliance programs for start-up Medicare Advantage plans. She ensured appropriate delegation oversight, successful audit and monitoring work plans based on risk assessment, and managed external audits with the Centers for Medicare and Medicaid Services. Elaine has lead audit readiness initiatives and developed and executed successful corrective action plans working with operational areas and delegated entities.
Prior to transitioning into a compliance role, Elaine held a variety of plan operations positions including managing the billing and enrollment teams, and leading business analysts. Elaine also participated in the implementation of three new Medicare Advantage plans, offering advice on operational structure and compliance. Elaine established compliant systems and processes for effective management of the new plan functions, including but not limited to enrollment and premium billing, sales and marketing, grievances and appeals, member services, claims processing, encounters, pre-service determinations, quality management, credentialing, network management, Medicare Part D operations and member retention.
Elaine holds a Bachelor of Science degree in Healthcare Administration from the University of Phoenix. She is certified in healthcare compliance (CHC) through the Compliance Certification Board and is a member of the Health Care Compliance Association.