Appeals & Grievances Solutions Appeals & Grievances When it comes to appeals and grievances, healthcare organizations are struggling to improve compliance, increase productivity, raise quality scores, minimize penalties, enhance reporting, and boost member and provider satisfaction. Our NCQA Accredited services deliver proven solutions to improve compliance and boost quality scores, such as 5-star ratings. By …
208 S Hoover Blvd.
Tampa, FL 33609
Jay Taylor is the director of configuration for Beacon Health Solutions He has worked in healthcare for the last 17 years holding positions in provider practice operations, business development, marketing, revenue cycle management and Medicare Advantage.
Mr. Taylor earned a Bachelor of Arts degree in political science from the University of South Florida and Master’s degree in business administration from Florida International University.
He is a member of the American College of Healthcare Executives and is looking forward to one day earning his FACHE.
Nicole Montgomery serves as Beacon Health Solutions’ senior director of operations specializing in client services and process improvement.
Ms. Montgomery has more than 15 years of managed care and pharmacy experience. Someof her specialties include operations, process improvement, audit readiness, quality improvement, customer service, appeals and grievance, corporate training, reporting and business analytics, new business expansion, and compliance in Medicare, Medicaid, employer group and commercial insurance.
Ms. Montgomery has a Bachelor’s degree in the natural sciences from the University of Pittsburgh specializing in neuroscience, biology, physics with a minor in chemistry and a certificate in the Foundations of Medicine- Philosophy of Healthcare and Healthcare Professionals.
Amy Leppin is the Vice President of Operations at Beacon Health Solutions. In this Role, Ms. Leppin supports our Chief Operations Officer in ensuring effective and efficient processes are implemented, maintained and executed throughout the organization in support of the excellent quality of service Beacon proudly provides to its business partners.
The departmental areas of daily operations oversight include, Claims and Utilization Management. Prior to joining Beacon Health Solutions, Ms. Leppin served at Ultimate Health Plans, Physicians United Plans, as well as, AvMed health Plans based in Florida in multiple Operations Leadership capacities.
Ms. Leppin’s experience is supported via an impressive portfolio containing a vast array of leadership skills employed within over 25 years of dedication in the health care industry.
Darpan Patel is the Vice President of Information Systems (IS) at Beacon Health Solutions. Within IS, Mr. Patel is responsible for overall strategy, direction and oversight of multiple areas related to Data and Systems in conjunction with Operational areas that include Business Analytics and Development, Release Management, Vendor Relations, Regulatory Data Submissions and Data Migrations.
While at Beacon, Mr. Patel has been at the core of developing and enhancing processes that have allowed for high quality cost effective solutions for the clients.
Prior to Beacon, Mr. Patel has held Director and Manager positions for Risk Adjustment/Revenue Management at Global TPA for Freedom and Optimum Health Plans of Florida as well as been in a Sr. Financial Analyst role. Mr. Patel has earned an MBA degree from USF with concentrations in Finance, Information Systems and Entrepreneurship.
Dhana Leal serves as the Director of Project Management Office, responsible for all new client implementations.
Dhana joined Beacon Health Solutions in 2017 with extensive experience in project management practices and processes. In the last 25 years, Dhana has participated in various leadership roles within the health care industry, related to customer service, operations, information technology and process improvement.
A few of Dhana’s successes are attributed to facilitating the transformation of diverse business organizations via the implementation of processes and procedures which have enabled overall effectiveness and efficiency based on organizational development methodologies and practices.
Other successes have been directly related to completion of intricate projects of complex regulations and/or requirements; related but not limited to, UDS Reporting for FQHC’s, Meaningful Use Certification for Electronic Health Records, City of Miami first place recognition for Business Disaster Recovery Plan and diverse Methodical Business Reporting.
Dhana holds an associate degree in Political Science and training certifications in leadership, customer service and organizational development.
Stephanie Dague serves as the Director of Implementation Interfaces, responsible for the integration of diverse internal and external systems supporting Beacon’s valued partnerships.
Ms. Dague joined Beacon Health Solutions in 2009 and has held multiple positions during her tenure, including Directors of Project Management and Configuration, which facilitated her extensive knowledge of business systems and operations in the healthcare space.
With over 18 years’ experience in operations and project management, systems integration, and process documentation and improvement Ms. Dague leads her dedicated team to develop sustainable, scalable processes for the organization that meet our client’s needs.
The ability for system technologies to support streamlined business operations is essential to the success of both our partners and Beacon as an organization. Ms. Dague understands and uses this knowledge to drive cohesive relationships and improvements that support Beacon’s overall mission and success.
Michael Hagan is responsible for the executive leadership of call center and enrollment operations for Beacon Health Solutions. He directs the strategic goals and day-to-day operations for the Call Center, Enrollment, and Appeals & Grievances teams.
Michael is a highly accomplished career professional, with a well-rounded background in health insurance and call center industries. He achieved over twenty years of experience in the areas of medical customer service, corporate training, Appeals & Grievances, claim processing, and configuration within the health insurance industry, focused more on Medicare and Medicaid.
Prior to joining the health insurance industry, Michael served four years with the US Army. Michael attended St Petersburg College, with a focus on a degree in Educational Studies.
Teri Kaminski joined Beacon Health Solutions, LLC as the Vice President of Product Development in March 2019. Teri comes to Beacon with over 25 years experience in the Healthcare field, primarily in Health Plan Operations from both the Business Operations, as well as, Information Services.
Teri’s accomplishments originate from her professional dedication to providing outstanding healthcare operations support from Sales and Enrollment through Claims and Provider Payments. Other aspects of Teri’s successes are in streamlining processes to increase efficiency using several process improvement methodologies, such as, Lean Six Sigma, Total Quality Management (TQM), Agile; as well as, Process Re-Engineering.
Graduated in 2013 from Purdue Global, formally Kaplan University, with a degree in Healthcare Administration.
Theresa Tucker joined Beacon Health Solutions, LLC in May 2018 as VP of Operations for Beacon Health Solutions, currently overseeing our Member Services, and A&G departments.
Theresa has nearly 20 years’ experience in healthcare operations, claims payment, and regulatory compliance.
Theresa is especially skilled at building effective, productive internal and external relationships. Previously, Theresa worked as Director of Claims and Revenue Cycle Operations for a California based Medicare Advantage Plan.
Theresa is an honor graduate from California State University with a degree in Healthcare Administration.
Amy Leppin is the Vice President of Operations at Beacon Health Solutions. In this Role, Ms. Leppin supports our Chief Operations Officer in ensuring effective and efficient processes are implemented, maintained and executed throughout the organization in support of the excellent quality of service Beacon proudly provides to its business partners.
The departmental areas of daily operations oversight include, Claims and Utilization Management. Prior to joining Beacon Health Solutions, Ms. Leppin served at Ultimate Health Plans, Physicians United Plans, as well as, AvMed health Plans based in Florida in multiple Operations Leadership capacities.
Ms. Leppin’s experience is supported via an impressive portfolio containing a vast array of leadership skills employed within over 25 years of dedication in the health care industry.
James Reese joined Beacon Health Solutions, LLC as the Senior Vice President of Operations in April 2019. James began his career in managed care in 1996 within a multi-state Medicare and Medicaid HMO. From there, he moved to Blue Cross Blue Shield of Florida where he progressed through successive operational roles in Claims, Customer Service, Configurations, Credentialing, and Provider Relations, before moving into analyst, auditor, architect, leader, and consultant roles in Information Technology and Business Process Management.
James has a demonstrated history of improving the integration and optimization of people, processes and technology, using defined methodologies such as Lean and Six Sigma for process improvement; and SDLC, RUP, Waterfall, and Agile for solutions development.
James holds a Bachelor of Science in Health Administration from the University of North Florida (1997) and will be earning his Master of Information Systems from Florida State University (May 2019).
Michael Friel joined Beacon Health Solutions, LLC as the Compliance Officer since January 2019. Michael is a highly motivated manager/attorney with a strong compliance-related background. Offers exceptional team-building and customer service skills with a proven record of exceeding goals.
Experienced in all facets of corporate life, from both a business and legal perspective—including managing, maintaining and expanding corporate relations. Expertise in insurance, contracts, human resources, employee benefits and corporate governance.
Mike obtained his Juris Doctorate from Western New England College Law School in 1993. Mike’s extensive career and experience in Compliance range from Sr. Regulatory & Compliance Investigator role at WellCare to Compliance Directorship roles in Aetna and Florida HealthCare Plus and Compliance Business Partner at Cardinal Health. Additionally, Mike’s legal practice encompassed specializing in Medicaid/Medicare compliance and representing individuals for disability benefits.
Chief Operations Officer at Beacon Health Solutions. In this role, Ms. Mahoney is responsible for providing leadership, strategic direction and oversight of day to day operations.
Operation areas include Claims, Customer Service, Enrollment, Systems Configuration, Business Development and Organizational Performance. Since joining Beacon Health Solutions, Ms. Mahoney has been a driving force to implement operational efficiencies that have led to low administrative costs and high customer satisfaction.
Prior to joining Beacon Health Solutions, Ms. Mahoney served as the Vice President of Configuration Global TPA, A TPA serving Freedom Health Plan and Optimum Health Plan of Florida. She also worked in management positions at WellCare Health Plans and Blue Cross and Blue Shield of Florida.
