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Susan JanzenSusan Janzen

Consultant

Susan Janzen is a Consultant at BluePeak Advisors, a division of Gallagher Benefits Services, Inc.  She has been in the healthcare industry for over 20 years and has held leadership roles in both Compliance and Operational areas. Susan specializes in Regulatory Compliance, with an emphasis on Organizational Determinations, Appeals and Grievances (ODAG) and Medicare Part C Reporting. Her expertise includes CMS and Commercial Health Plan audits, Corrective Action Plan remediation, Policy & Procedural documentation reviews and end-to-end claims processing and procedures.

Prior to joining BluePeak Susan was a Director of Compliance responsible for claim audits and regulatory reporting. She performed various compliance activities including audit oversight/monitoring, and corrective action plan remediation. Susan was also responsible for Medicare Part C reporting and data universe integrity. Previously, Susan was employed at a national Managed Care Organization as a Delegation Oversight Manager responsible for the oversight of 40+ delegated downstream claim vendors. She completed both onsite and virtual audits at least annually for each vendor to determine compliance with CMS and health plan guidelines and was responsible for reporting her findings at monthly delegation oversight committee meetings.

Susan started her healthcare career as a claims processor, learning healthcare compliance from the ground up, and is considered a subject matter expert in claims processing and compliance.

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Experienced Medicare staff: Ready when you are!

BluePeak knows how difficult it can be for Medicare Advantage plans and TPAs to find knowledgeable resources with experience in Medicare, especially when demands increase sharply given the Medicare annual cycle. BluePeak maintains a wide variety of experienced Medicare personnel to help you with seasonal projects, operational backlogs, compliance monitoring, remediation activities, and more.

Examples of projects that BluePeak has assisted plans in 2022 include:

  • Clinical chart review by licensed clinicians
  • Call center oversight, including listening to calls for accurate classification and calibration
  • Operational support to resolve grievance backlogs and provider directory compliance
  • Pharmacy support to resolve coverage determination backlogs
  • Program area specific operational and administrative responses to a corrective action (initiated internally or externally)
  • Compliance resources to support compliance program initiatives

Whether you need one resource or many, BluePeak can quickly staff any project, train resources, track results, and deliver success.

Contact us today!