Eric Dodson

Background

About Eric Dodson

I am a licensed attorney in the Commonwealth of KY. I have fourteen years of government service, nine years at Humana, and more than thirteen years of experience in compliance enforcement and risk assessment and management. I am a certified Lean Leader. I am currently engaged as a Strategy Advancement Advisor, Provider Network, Corporate Medicaid implementation. I work in the area of new state Medicaid implementations to ensure that provider networks and contracts in new states are compliant with state regulations. I assess state statutes and RFPs for compliance concerns and in order to develop the provider network to account for these concerns and to ensure network adequacy. From January 2022 to January 2023 I was the Network Operations Lead for Medicaid Behavioral Health implementations in all implementation states. From April 2020 until January 2022 I was engaged as a Senior Compliance Professional with Medicare Regulatory Compliance in the area of providers and provider networks. In this role I provided regulatory guidance and helped lead program areas and operations to outcomes compliant with CMS and federal regulations. In addition to this I conducted program and process audits to identify strengths and deficiencies and to provide education for correction. As part of this role I also led and participated in a variety of workgroups to address identified needs. I was the Lead Investigator for HCS Clinical Compliance & Risk Management Home Investigations Unit and since March 2016. I was personally been responsible for over forty percent of investigations and over one-half of all submitted recoupment for fraud, waste, and abuse on a unit with three or four investigators. I developed and managed the reporting and tracking system for regulatory misconduct and processed and fulfilled all subpoenas for this area of business and produced reports to track trends from this data. Throughout my career I have created process improvements to improve outcomes for members and the business, including a care management delivery model with the OH Demo to improve staff efficiency, duty to warn/report for Humana at Home, investigative procedures to increase productivity and quality, and the In-Home management audit processes to improve quality of care and detect fraud, waste, and abuse. I am motivated by efficiency and thrive in fast-paced and result-driven environments.