Maureen is a specialist with the Medicare Advantage (MA) and Medicare Prescription Drug (PDP) programs. She advises clients on Medicare regulations and CMS program guidance and has assisted health plans and PBMs with operations and implementation issues in several program areas. She is highly experienced in compliance gap analysis of plan operations, preparation for CMS audits, development of corrective action plans, policies and procedures, and training. She has particular expertise in the areas of organization determinations (MA) and Coverage Determinations (Part D), appeals and grievances.
Previously, Maureen was the Senior Policy Analyst at CMS for the Medicare managed care program. In this capacity she developed the initial regulations and operational guidance, much of which is still used in the Medicare Advantage and the Medicare Prescription Drug programs. At CMS she had a role in shaping program strategy and requirements as well as in legislative development.
Prior to her work with managed care, her tenure at CMS included positions in other Medicare programs including five years serving as Special Assistant to top CMS leaders including the Administrator.
At CMS, Maureen served as a liaison with health plans, providers, consumer groups, national associations, federal and state officials and represented CMS in the development of several policy initiatives and national operational standards. She worked closely with the National Association of Insurance Commissioners (NAIC) in developing model health care accountability standards, and with The Joint Commission developing standards for health care networks. She also provided guidance to the managed care industry association and beneficiary groups on Medicare issues.
Maureen has periodically been tapped for special assignments including a Secretarial commission on the national nursing shortage, a Congressionally–mandated work group on provider-sponsored organizations and the President’s Commission on Complementary and Alternative Medicine Policy where she was responsible for coverage and reimbursement issues. She has spoken widely on Medicare legislation, regulations, and trends in Medicare managed care. She has authored numerous articles that have been published in managed care trade publications, and contributed to other publications.
Maureen Miller has a Bachelor of Science in nursing from St. Louis University in St. Louis, MO and a Master of Public Health degree from Tulane University in New Orleans, LA. She worked as a hospital nurse for several years before becoming an officer of the U.S. Public Health Service. During her CMS career, she rose to the rank of Captain (Navy).
Maureen Miller lives in Washington, DC.