Melanie Carrozza, CMSP
Vice President, Operations
Melanie is Vice President of Operations for Optum Settlement Solutions. In her role, Melanie’s focus is to automate processes and policies related to research, management of goals, cost controls, and profit attainment for Optum Settlement Solutions, in addition to overseeing the operational managers to ensure quality control. Previously as Executive Director over our Account Management team, Melanie served as a primary account-level point of contact for our top national clients and managed all aspects of assigned clients’ program performance and support. In addition, Melanie is charged with the responsibilities of driving strategic initiatives, overseeing program development and implementation, identifying growth opportunities, monitoring outcomes, and regularly analyzing program performance to ensure clients get the most out of their partnership with Helios. Melanie has over fourteen years of experience in the workers’ compensation industry and has focused on the Medicare Set-Aside business for the last ten years. Prior to joining Optum, Melanie was the Director of Sales for Coventry Workers’ Compensation Services (CWCS) overseeing sales for Nurse Case Management, Medicare Set-Asides, Durable Medical Equipment and Independent Medical Examination services. Melanie has a Masters in Management and a B.S. in Exercise Physiology.
Brenda Smith, MSCC, CMSP
Manager, Medicare Mitigation Unit
Brenda serves as Manager of the Medicare Mitigation Unit with responsibility for the oversight of Optum Settlement Solutions clinical cost mitigation programs and manages a team of clinical pharmacists, registered nurses, and support staff. Additionally, she has oversight of our internal Quality Control program. Brenda has over twenty five years of experience in the workers’ compensation industry and has focused on the Medicare Set-Aside business for the last thirteen years. Prior to joining Optum, Brenda was a workers’ compensation claims supervisor with responsibility for a team of both technical and support staff. Brenda holds a Bachelors degree in Psychology and holds the following certifications: Medicare Set-Aside Consultant Certified (MSCC) and Certified Medicare Secondary Payer Professional (CMSP).
Lavonya Chapman, Esq., RN, CMSP
MSP Compliance Counsel
As Medicare Secondary Payer Compliance Counsel, Lavonya Chapman is as a consultant on Medicare Secondary Payer (MSP) claim compliance issues, including Mandatory Insurer Reporting, ICD injury code reporting, Conditional Payment Resolution, Medicare Set-Aside Allocations, CMS approval and professional administration.
Prior to joining Optum, Lavonya served as director of MSP compliance for Arthur J. Gallagher & Company. She was also the claim director for a new liability captive in which nearly all the claimants/plaintiffs were Medicare beneficiaries or dual eligible. Additionally, Lavonya has experience in private law practice, litigating medical malpractice, premises and auto liability claims as well as workers compensation cases. As a registered nurse and pharmacology instructor at the University of Alabama at Birmingham, Lavonya is an expert in utilization review and emergency medical services.
Lavonya presents on all aspects of the Medicare Secondary Payer Act as it pertains to claim compliance in the Property & Casualty system. She received a Bachelor of Science degree in nursing from the Samford University and a Doctorate of Jurisprudence from Birmingham School of Law.
Vice President, Medicare Compliance Reporting & Development
Frank is Vice President of Medicare Compliance Reporting and Development for Optum Settlement Solutions and has nine years of experience in MMSEA Section 111 reporting and Medicare Secondary Payer Compliance. In his expanded role, Frank will help formulate strategic direction and drive new product and technology-driven solutions for our clients. Frank previously managed MedicareConnect℠, Optum’s proprietary platform for Non-Group Health Plan reporting requirements mandated by Section 111 of the Medicare, Medicaid and SCHIP Extension Act of 2007. Frank has over twenty years of experience in the financial and telecommunication industries working for multinational companies including AT&T and Orange/France Telecom, where he managed areas of contract administration, order management, billing and revenue recognition. Frank has a Bachelor of Applied Science in Technology Management from St. Petersburg College.
Evelio Prieto, Pharm.D., RPh., CPh.
Evelio is a pharmacist and a consultant pharmacist registered in the state of Florida. He is part Optum’s Clinical Center of Excellence and is dedicated to the settlement solutions division. He has more than 24 years experience as a pharmacist. In his current role, he is responsible for applying his clinical expertise to review prescription allocations in the Medicare Set-Aside product, reviewing and setting up medication analysis cases for claimants and helping to improve and streamline processes to improve turnaround times. Evelio has worked as a pharmacist in the Optum settlement solutions department for four years. Prior to Optum, Evelio managed two local hospital outpatient and ambulatory infusion pharmacies (Tampa General Hospital and All Children’s Hospital John’s Hopkins Medicine). Prior to this, Evelio spent 15 years managing a Walgreens pharmacy. Throughout his career, Evelio has worked with worker’s compensation and managed care Pharmacy Benefit Managers (PBMs) as well as Medicare Part B and D billing to ensure care for claimants in the community. Evelio served on the Florida Medicaid Drug utilization review board from 2010 to 2015. He is a graduate of the University of Florida College of Pharmacy where he earned a Doctor of Pharmacy degree in 1994.