Amy Kerstetter is a Consultant at BluePeak Advisors, a division of Gallagher Benefit Services, Inc. Amy has over 20 years of experience in the health insurance industry with specialization in Regulatory Compliance, Corporate Compliance, Auditing and Monitoring, and Quality Programs. Amy has served as the compliance subject matter expert for several Health Plans before, during, and post CMS audit activities in the ODAG, CDAG, and CPE areas of CMS Audits as well as provided support to operational areas including Enrollment, Pharmacy, Utilization Management, Claims, Appeals & Grievances, and Special Needs Plans (SNP MOC). Amy has also led operational areas through recent Market Conduct Exams for Commercial Health Insurance.
Prior to becoming a Consultant, Amy worked for one of the nation’s largest national Health Plans and created end to end Quality Programs for Medicare Part C and Medicare Part D Enrollment (including Low Income Subsidy, Late Enrollment Penalty, Reconciliation, and all Letters) Appeals and Grievances, and Call Centers. Amy also created Key Performance Indicators and end to end Compliance Monitoring Programs for Medicare Part C and Medicare Part D Operations in order to optimize Compliance and drive continuous Process Improvement while developing strong business relationships all levels of management down to front line staff. During her tenure at this company, she was also successful in recouping thousands of dollars by serving as subject matter expert of the Medicare Secondary Payer (MSP) process and training others on the process as well.
Amy has worked at at other smaller Health Plans and First Tier Entities, including a Quality Improvement Organization (QIO) in various compliance roles including Medicare Operational Compliance, Regulatory Compliance, Corporate Compliance, and Internal Audit. In these various roles she led Risk Analysis and Remediation efforts, continued creating end to end Compliance Monitoring Programs (including First Tier and Down Stream Entities), creating and initiating Internal Audit programs (including First Tier and Down Stream Entities) in all Medicare Part C and Medicare Part D Operational Areas including the Special Investigations Unit and Commercial Operations (Affordable Care Act). Amy also specializes in Root Cause Analysis and Corrective Action Plans to successfully remediate any areas of non-Compliance.