Jill Pepe is currently a Consultant with BluePeak Advisors. She is a healthcare professional with over 12 years’ experience in Medicare Advantage with expertise in product development, regulations, Part D formulary administration, and coverage determinations. Jill has supported and participated in numerous audits with her primary expertise in Formulary Administration (FA) and Part D Coverage Determinations, Appeals and Grievances (CDAG) and Online Provider Directory reviews for Medicare Advantage (MA-PD) plans.
Prior to BluePeak Advisors, Jill worked for a large health insurance company where her role as Program Manager, Healthcare Services integrated her into the business operations where she gained insight into Utilization Management process and compliance. In addition, Jill worked to plan, develop and implement business critical programs and projects.
Previously, Jill was Manager of Government Pharmacy Programs where she was responsible for Pharmacy Benefit Manager, (PBM) oversight and compliance, audit readiness, and quality monitoring. Her team created a quality assurance program to monitor daily rejected claims, transition, and coverage determinations. Jill supported formulary submissions and bid filling deadlines to ensure CMS acceptance.
Jill has held additional management positions in the healthcare industry, including Product Manager for Medicare. She was responsible for interpretation of regulations and coordinating cross functional teams throughout the organization to develop competitive plan offerings that supported sales and medical loss ratio goals.
Jill received her Master of Arts in Organizational Leadership from Medaille College and holds a B.S. degree in Business. She is a certified Project Management Professional (PMP).