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Jana Pingle


  • Managed care claims
  • Customer service
  • Premium billing
  • Client services
  • Enrollment/disenrollment
  • System implementation
  • Regulatory compliance

Ms. Pingle is independent Health Care Operations Consultant and has twenty-five years+ of experience working with health plans and integrated delivery systems in managed care as well as PPO and indemnity administrative operations in the health care industry. Her prior experience includes work with some of the leading companies in the nation including FHP, Sutter Health, Neighborhood Health Partnership, Health Net of California, Maxicare, Blue Shield of California, FHP Life Insurance Company, National Insurance Administrators and Aetna.

Through her extensive experience working with health care organizations, Ms. Pingle has specific expertise in claims, customer service, premium billing, client services, enrollment/disenrollment, system implementation, professional services billing, and regulatory compliance.

As an independent consultant, Ms. Pingle:

 

  • Served six months as interim Chief Operations Officer of the MSO for Sutter Health, the largest integrated delivery system in Northern California
  • Directed a multifunctional team consisting of internal and external consultants during a ten month project to construct initiatives, blueprints and business cases aimed at transforming a large California HMO into an internet enabled, consumer oriented health plan
  • Led projects in the identification and implementation of workflow/process efficiencies
  • Led systems selection and implementation efforts
  • Provided customer service strategy development and implementation
  • Assisted clients with compliance in Medicare+Choice administrative operations
  • Developed and delivered Medicare+Choice audit and training programs
  • Provided Division of Financial Responsibility contract analysis
  • Led a large HMO in developing and successfully completing a Corrective Action Plan for a failed state regulatory compliance audit

    In her last role prior to becoming a consultant, Ms. Pingle served as Vice President of Operations for FHP’s insurance company. Prior to that, she served as an internal expert consultant for FHP which was at the time one of the nation’s largest and most successful HMOs. In this capacity she led a team whose goal was to create company-wide policies and procedures with an emphasis on Medicare+Choice compliance.