With a wealth of experience in health care compliance and regulatory matters, Alex serves as a trusted advisor to managed care organizations (MCOs) across the country. She frequently advises clients on compliance with key legislation, including the Consolidated Appropriations Act of 2021, reproductive care and gender-affirming care laws, and various government program requirements. Alex also has experience addressing specific compliance issues involving Medicare Advantage Organizations, Medicaid Managed Care Organizations, Marketplace products, and Employee Retirement Income Security Act (ERISA) plans and administrators.
Alex is regarded as a leading national authority on the No Surprises Act (NSA) and its implications for MCOs. She advises her clients on wide-ranging NSA compliance issues, oversees administration of the NSA’s independent dispute process for multiple organizations, and aids in internal and regulatory audits to ensure NSA compliance. Additionally, she advises payors regarding compliance with the Transparency in Coverage rules, Medicare Advantage marketing rules, provider directory compliance, medical loss ratio reporting, privacy and interoperability requirements, and state and federal benefits mandates.
Alex also represents MCOs in litigation and arbitration proceedings, including those related to ERISA and government program compliance, contractual payment disputes with hospital systems and providers, and high-volume claim disputes with out-of-network providers.
Alex is uniquely positioned to represent MCOs as her in-depth industry knowledge and subject matter proficiency go beyond just the legal matters. This includes a comprehensive understanding of procedural and diagnosis coding, various payment methodologies such as diagnosis-related groups and the outpatient prospective payment system, National Correct Coding Initiative edits, utilization management and front-end claim processing, actuarial considerations, and operational implementation of coverage requirements. This broad experience has equipped her to effectively navigate and resolve complex challenges that payors encounter in the industry.
Alex is deeply passionate about legal technology and has developed innovative legal technology solutions that MCOs can access through a subscription-based model. Among these offerings are the Post-Dobbs Tracker and the Gender-Affirming Care Tracker, which provide real-time updates on state and federal laws concerning reproductive care and gender-affirming care, as well as tailored analyses of associated payor risks. Alex is actively working on creating other similar technology offerings to further assist MCOs in their legal compliance endeavors.
