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Amy Kerstetter Portrait

Amy Kerstetter

Amy Kerstetter is a Consultant at BluePeak Advisors, a division of Gallagher Benefit Services, Inc.  Amy has over 20 years of experience in the health insurance industry with specialization in Regulatory Compliance, Corporate Compliance, Auditing and Monitoring, and Quality Programs. Since being at BluePeak Advisors, Amy has specialized in Mock CPE Audits,  Mock ODAG Audits, Enrollment Audits, Call Center Assessments and Training, and Marketing Material Reviews.

Prior to becoming a Consultant, Amy worked for one of the nation’s largest national Health Plans and created end to end Quality Programs for Medicare Part C and Medicare Part D Enrollment (including Low Income Subsidy, Late Enrollment Penalty, Reconciliation, and all Letters) Appeals and Grievances, and Call Centers. Amy also created Key Performance Indicators and end to end Compliance Monitoring Programs for Medicare Part C and Medicare Part D Operations in order to optimize Compliance and drive continuous Process Improvement while developing strong business relationships all levels of management down to front line staff.

Amy has worked at other smaller Health Plans and First Tier Entities, including a Quality Improvement Organization (QIO) in various compliance roles including Medicare Operational Compliance, Regulatory Compliance, Corporate Compliance, and Internal Audit. In these various roles she led Risk Analysis and Remediation efforts, continued creating end to end Compliance Monitoring Programs (including First Tier and Down Stream Entities), creating and initiating Internal Audit programs (including First Tier and Down Stream Entities) in all Medicare Part C and Medicare Part D Operational Areas including the Special Investigations Unit and Commercial Operations (Affordable Care Act). Amy also specializes in Root Cause Analysis and Corrective Action Plans to successfully remediate any areas of non-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!