Jaymie Billbrough is a registered nurse and Senior Consultant with BluePeak Advisors with over 25 years’ health care experience in government programs. Jaymie has held management positions with managed care organizations and worked for the Centers for Medicare and Medicaid Services (CMS) specializing in Medicaid, Medicare Advantage and Prescription Drug Plan operations for over 7 years. At BluePeak, Jaymie consults with health plans and their contractors on compliance, utilization and case management and program operations including government audit readiness and assisting remediation efforts and process improvements. Jaymie performs CMS validation audits for Parts C Organization Determinations, Appeals, and Grievances (ODAG) and Part D Coverage Determinations Appeals and Grievances (CDAG), Special Needs Plans (SNP) and Medicare Medicaid Plans (MMP) contractors.
Prior to joining BluePeak, Jaymie was Director of Operational Excellence at Independence Blue Cross (IBC) in Philadelphia Pennsylvania responsible for Medicare Advantage Prescription Drug operational process improvements, federal and state audit preparation, regulatory corrective action responses and NCQA survey support. Prior to joining IBC, Jaymie was Head of Medicare Star Strategy for Aetna, Inc. where she was responsible for the development and implementation of an integrated approach to improve Medicare Star ratings. She also held the role of Medicare Compliance Officer for over six years while at Aetna, overseeing all aspects of the Medicare, Individual and Medicare Supplement Compliance Programs.
Prior to her health plan work, Jaymie was a Health Insurance Managed Care Specialist with CMS overseeing Medicare Advantage and Prescription Drug Card contracts performing audits, corrective action plan management, application approvals and ongoing assessment and monitoring of managed care organizations. Jaymie also worked for PriceWaterHouseCoopers as a senior consultant of Medicare Managed Care & Provider Service Organizations and has performed clinical nursing services at the Hospital of the University of Pennsylvania and other large hospital systems in the Philadelphia area.