Erin Heckethorn

I’m a compliance executive with 30 years of experience across managed care, including Medicare Advantage and Part D programs, commercial fully insured, and self-funded plans. I lead enterprise compliance programs aligned to CMS, state regulatory expectations, and accreditation needs—grounded in deep expertise across all seven elements of an effective compliance program.

In my roles, I build, govern, and operate compliance programs that drive FWA prevention and detection, strong board-level oversight, and disciplined audit readiness. I’ve led Medicare Advantage and Part D program audits, supported CMS bids, and managed state Department of Insurance market conduct exams and financial audits through disciplined preparation and corrective action execution.

I also design and run Audit and Monitoring programs with root cause analysis and corrective action plan governance to improve resolution timeliness. I oversee First Tier, Downstream, and Related Entity (FDR) pre-delegation and annual oversight reviews (including PBMs and supplemental vendors), ensuring regulatory adherence and mitigating cross-functional risk.

Beyond compliance, I’ve brought measurable operational results—eliminating quality services backlog by redesigning workflows and reducing audit follow-up and resolution cycle time from 6 months to 10 business days. I also serve as a trusted subject matter expert for mergers and acquisitions, supporting regulatory due diligence and post-acquisition integration.