Linda J. Gallagher has over 10 years of experience in Medicare operations and compliance at MVP Health Care, currently serving as a Medicare Process Manager. She leads cross-functional teams responsible for front and back-end Medicare processes to ensure compliance with CMS regulations. Gallagher has implemented process changes resulting in multi-million dollar savings and ensures marketing materials comply with annual guidelines. She is pursuing a BS in Health Sciences Administration from SUNY Brockport and has a strong track record of managing teams and workloads in a regulated, high-volume environment.

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Linda J. Gallagher
71 Carlisle St, Rochester, NY 14615 585.327.5787(W), 585.330.7223 (Personal/business cell)
lgallagher@mvphealthcare.com (W), lxg57@yahoo.com (H)
Highlights of Qualifications
 Lead cross-functional operational teams responsible for ensuring compliance with CMS regulations
in both upfront (enrollment, premium and billing, pharmacy) and back end (Appeals & Grievances,
Claims, Medical Policy, Contracting) processes. Teams successfully address changes in Plan
benefit, Medicare and NGS requirements.
 Implemented, audited, and trained on hospice process changes resulting in multi-million dollar
savings
 Prior owner of Medicare Marketing document review team charged with review, filing tracking
compliance of all materials sent to Medicare members; implemented yearly changes for Medicare
Marketing Guidelines; ensured compliance by all affected areas
 Acted as Claims team lead for Value Options Mental Health and Buffalo Expansion projects;
Medicare SBU team lead for MESI; Facets upgrades; claims backup for MaxMC; and MSBU
backup for ID card project; EIP, MSBU team lead for ICD-10 project tracks and Voice of Customer
Project, Part C EOB project- both HMO/PPO and MSA, electronic EOB and billing initiatives,
CarePlus project, Kodak Medicare Advantage Response Team, and MSBU claims lead for 2016
CMS plan wide audit of delegated entity.
 Successfully gathered requirements from all areas of MVP and submitted to CMS Part C&D
Readiness Checklists for 2010 and 2011, 2010 Medicare Out of Pocket audit, led 2012 Data
Validation Audit team, involved in 1/3 pharmacy audit teams, Denial letter audit team.
 Claims liaison to Strong Hospital; transplant coordinator; current Medicare liaison/manager for
Value Options (Beacon Health); Landmark, HEG.
 Medicare SBU owner of Health Economics Group dental process including eligibility/enrollment
extracts, oversight and reporting of claims auditing for Delegation Oversight Committee and CMS
plan audit, oversight of FWA process implementation, created; implemented and continues ensuring
compliance for Model Material requirements.
 Supervised Medicare claims team for plan ranked #1 in nation for 3 of 5 years.
 Skilled at managing diverse workloads and staff in high volume, high stress environment
 Skilled user of Facets, Excel, Word, Outlook, Med Class, AMISYS, Service Matrix and Max Mc.
Familiar with Visio, MS Project, Access and Maces
 Dedicated to all customers, Driven to Excellence and delivery of products of the highest quality.
 Matriculated College Student in Health Sciences program. 3.97 average, December 2016
graduation date.
 2016 Community Ambassador representing MVP at various events; participant in planning for
American Heart Walks in 2016 and 2017; volunteer for Meals on Wheels, Salvation Army Coats for
Kids and Roland Williams Championship Academy
Professional Experience
Medicare Process Manager II, MVP Health Care 01/2010-Present
 Possess thorough working knowledge of CMS regulations applicable to MA organizations
 Perform research to coordinate and resolve issues related to Medicare products
 Lead cross functional operations team tasked with front and back end processes, have acted as
backup to MSBU Director for Medicare Experts and Kodak MA response teams
 Document meetings, processes and procedures implemented in response to CMS regulations
 Act as Medicare SBU representative and Subject Matter Expert on project teams throughout the
company and ensure changes are compliant with regulations

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 Manage all aspects of relationships with external vendors HEG and Inspirus, CMS Regional office
and internal MVP departments and communicate results to upper management
 Shared responsibility for ensuring that all written materials issued by MVP and our external vendors
for Medicare members are reviewed, thoroughly documented and compliant with CMS regulations
 Fully aware of and accountable for all Medicare processes that I manage
HMO/ASO Government Programs Supervisor, MVP Health Care 02/2005-01/2010
 Supervised team of Medicare/Medicaid claims examiners in Rochester and Syracuse
 Assigned, prioritized, fully responsible for meeting mandated turnaround times
 Represented Claims in contract planning/implementation meetings; Delegate Oversight Committee,
claims training team, USA Care issue meetings, monthly Strong Memorial meetings
 Acted as AMISYS Claims team lead for Value Options project. Duties were diverse and included
coordination of efforts with operational areas at MVP/VO,IT/testing, provider/network teams and
all other areas to ensure success
 Accountable for team accuracy, productivity, regulatory adherence, hiring, training
 Communicated interactively with all departments to identify needs in other areas including Service
Center, UM, Case Management, Network and IT
 Gathered, reviewed, prepared and reported employee metrics and performance appraisals
 Actively pursued and participated in Medicare University training
Education
MVP/SUNY Brockport, Healthplex Delegation Oversight Internship with UM 2010-2016
 Training in NCQA, HEDIS, MVP UM & NYS Department of Health policies and requirements
 Performed Healthplex 2015 NYS DOH L-4 and L-10 reviews
 Updated MVP Provider Response Manual section
 Completed section of Healthplex file review for annual Delegation Oversight Committee (DOC)
and assisted in creating documents, attended DOC meeting
 Performed NCQA reviews of Healthplex claims for Q1 2016 and performed scoring
 Created 2016 NCQA roadmap for UM 1 Standard and elements
 Interviewed Healthcare Administrators
SUNY Brockport, Pursuing BS in Health Sciences Administration
2016
 Maintained 3.97/4.0 Average
 December 2016 graduation date
 Project Groups placed first out of six in Management and Marketing classes
Monroe Community College, AAS-Liberal Arts, with Distinction 2009
Medicare University Courses, CMS Webinars, Conferences, Testerfor classes ongoing
Wide Variety of CMS educational opportunities, SCRUM Product Owner training (2016),
Current Independent Adjuster’s License (Exp. 12/31/18)