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Paige Fiorillo is an experienced healthcare and auditing professional with more than eighteen years of experience in the healthcare industry. She has held multiple positions during her career in claims, auditing, compliance, operations, credentialing, delegated oversight, finance, UM coding/pricing and business planning and development. Prior to joining GHG, Paige worked for TriWest Healthcare Alliance, one of the three contractors for the TRICARE program. As a Senior Project Manager/Systems Analyst, she was responsible for identifying and proposing options for potential solutions to implement all government modifications to the TRICARE contract. Her focus was to improve business efficiency and productivity while being in compliance with all regulatory requirements, as well as the rollout and implementation of these work plans. She was also Project Manager & Interim Claims Manager for the Claims Administration Department, where she was responsible for the delegated oversight of 2.5 million claims monthly. In this position, she developed and maintained departmental workflow, policies and procedures, and implemented new programs from contract inception to roll out. Paige also worked for PriceWaterhouseCoopers in the Health Care Regulatory Department as a Senior Healthcare Compliance Associate. Her specialty was claims analysis, adjudication and auditing for multiple lines of business. She was also responsible for consulting and performing operational assessments and compliance reviews for various clients in the application process, including Health Plans, TPA’s, IPA’s, provider groups and PSOs. She also designed and developed companies’ claims review manuals, a claims review automated audit tool, and assisted with developing a regulatory manual and proposal material. During her tenure at a major California health plan, Paige served as the group’s first delegated credentialing audit coordinator and was responsible for reviewing all IPA/medical group policies and procedures against NCQA standards. She performed on-site audits and consulting with groups to assist them in meeting all of the delegation requirements for both the health plan and NCQA. She was a major participant in a successful NCQA and Department of Defense credentialing audit. Paige also was a presenter/trainer at the Oct 97 HCFA task force claims timeless training. | 