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Debra Nuckols

Debra Nuckols, a Consultant at BluePeak Advisors, a division of Gallagher Benefit Services, Inc. has been in the managed care industry for 20 years, specializing in Medicare compliance, corporate compliance, auditing and monitoring, and new-to-Medicare health plan start-ups. Prior to becoming a consultant, Debra worked for several national managed care organizations where she worked her way up to becoming a corporate Medicare compliance subject matter expert and served as Medicare Compliance Officer. She has also served as Medicare Compliance Officer for both local and regional health plans. In addition to her extensive health plan experience, Debra worked at the Centers for Medicare and Medicaid (CMS) in the Seattle Regional where she was plan manager for national and local Medicare MA-PD plans.

Debra has overseen the submission of multiple CMS Medicare initial and service area expansion applications and successfully developed and implemented various Medicare Compliance Programs over her career. She has experience working within health plan operational areas to implement MA-PD plans, including sales and marketing, CMS bid submission, appeals and grievances and network contracting. On a national level, Debra has experience establishing a compliance oversight program that includes compliance program staff training, first tier entities (FTE) oversight, sales and marketing, customer service and appeal and grievances. In addition, she has chaired various health plan compliance committees at the national and local levels. Debra has overseen complex compliance projects and led operational teams through corrective action plans with routine reporting to CMS. She has managed compliance teams that ranged from 3 to over 20 direct reports.

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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!