Senior Health Plan Services Consultant
Jeff Baker is a Senior Health Plan Services Consultant with BluePeak Advisors, a division of Gallagher Benefit Services, Inc., and has been actively engaged in the Medicare Part D industry since 2007. Jeff has over 15 years of management experience and his Medicare expertise includes a comprehensive insight into claim processing, Medicare payment methodologies, data analytics, and audit and monitoring.
Jeff has a proven track record of leading operational and technical teams to achieve defined goals within the complex Medicare environment. Jeff has an extensive background in managing and analyzing large data sets and has developed sustainable solutions to effectively monitor and manage key Part D operational areas including claim adjudication, PDE reporting, and formulary management. Jeff has partnered with Part D plans in performing in-depth analysis into their claims and PDE data and has developed compliant solutions to mitigate audit risks while optimizing CMS reimbursements.
Within BluePeak Advisors, Jeff has collaborated with various health plans and Pharmacy Benefit Managers (PBMs) to test and validate several complex Medicare Part D adjudication functions including formulary administration, plan benefit, CMS subsidies, pharma discounts, and transition of care logic. Using his experience of claims processing and formulary administration, Jeff has supported numerous program audits and has conducted several validation and mock audits with his primary expertise in Part D Formulary Administration (FA).
Prior to BluePeak Advisors, Jeff worked for a large national PBM as a program manager over several key operational Part D programs including PDE reporting, CMS required reporting, and claim reprocessing. Jeff then set out to start a new Employer Group Waiver Plan (EGWP) where he managed several key financial and operational functions including underwriting EGWP premiums, budget management, and developing oversight solutions to identify any adjudication, formulary or PDE issues.
Jeff currently resides in San Diego, California and holds a Bachelor of Arts in Psychology from California State University, San Marcos.