Greg Miller, RPh, is a Senior Health Plan Services Consultant at BluePeak Advisors, a division of Gallagher Benefit Services, Inc. An industry leader with Medicare operational experience, Greg focuses on CMS program audits, Pharmacy Benefit Manager (PBM), pharmacy and oversight auditing in addition to Formulary Administration (FA), Coverage Determinations, Appeals and Grievances (CDAG) operations. Throughout his career, Greg has conducted and supported clients in over 15 Independent Validation Audits (IVA) and over 35 CMS Program Audits and Mock CMS Program Audits.
In his previous management experience in the PBM industry, Greg developed, implemented and guided a team of associates dedicated to supporting the PBM clients through CMS operational audits. This included full CMS program, Transition Monitoring Program Analysis (TMPA), Formulary Administration Analysis (FAA), Mail Order and client initiated mock audits. He led his team in preparing clients’ audit universe files, quality assurance practices, mock audit preparation and also provided guidance on operational and audit best practices. He also presents as a subject matter expert at industry conferences.
While at the PBM, he led a team that developed, coded and implemented a robust Medicare Part D daily claim review reporting and analytic capability for the PBM’s clients. He was involved in several management developmental training programs including being trained in six sigma black belt and process improvement methodologies.
Prior to his PBM experience, Greg held management positions in the retail pharmacy arena. While there, he gained experience in National Council for Prescription Drug Programs (NCPDP) claims adjudication, prescriber file database creation, maintenance and monitoring and claims editing for audit avoidance. In addition, he held positions where he gained experience in overall retail pharmacy management, operations and curriculum training and development.