Jeff Baker
Senior Consultant
Jeff Baker is a highly experienced and knowledgeable Medicare Part D consultant with a passion for helping all industry partners navigate the complex world of prescription drug coverage. With over 16 years of experience in the Part D industry, Jeff has developed a deep understanding of the intricacies of Medicare Part D operations, financial life cycle, auditing methodologies, and data analytics.
Prior to BluePeak, Jeff worked as a Program Manager for a large national PBM. During this time, Jeff was responsible for managing several key Part D operational areas including the PDE process, CMS required reporting, and claim reprocessing. Jeff then set out to start a new Employer Group Waiver Plan (EGWP) where he supported several key financial and operational functions including underwriting, budget management, and implementing oversight solutions around claim adjudication, formulary administration, and PDE.
With a strong background in Part D and a commitment to staying current with the latest changes and updates in Medicare regulations, Jeff has hosted several company webinars to provide internal and external clients with a comprehensive understanding of the complexities of the regulations update along with possible operational impacts to their organization. Jeff has developed sustainable and compliant solutions to key operational areas including pharmacy claim adjudication, Prescription Drug Event (PDE) analysis and reporting, and formulary management. Jeff is actively engaged in CMS program audits and provides ongoing education, program audit support, and performing auditing within the Formulary Administration (FA) program area. Jeff has created technological solutions to analyze formulary management trends, drug costs and utilization patterns, and creating risk models to review client and CMS financial exposure.
Jeff holds a bachelor’s degree in psychology from California State University, San Marcos.