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Michelle Rigby

Michelle D. Rigby, CFE, CHC is Director, Client Services at BluePeak Advisors, a division of Gallagher Benefit Services, Inc.   Michelle has 20 years of health care compliance experience at both the health plan and Pharmacy Benefit Manager, (PBM) level to include Medicare, Medicaid and Commercial products. She possesses extensive knowledge in the areas of insurance investigations, government audits, PBM services, Medicare A, B, C and D, Medicaid and Commercial Health Plans.  She has recently been an Interim Compliance Officer at an MA Plan and supported them through a CMS Program Audit. The focus of her position is to assist clients with their needs in compliance, audits and Fraud, Waste and Abuse, (FWA) as well as interpretation and adherence to governmental regulations.

She has been involved in Medicare Part D since its inception in 2006, helping to launch a plan comprised of seven Blue Cross Plans as well as building the compliance program at a large PBM.    Michelle has been the lead auditor on 20 CMS Program audits her expertise is in CPE, CDAG and FA.  She has completed over 200 CMS audits to date. Her collaboration with operational leads for quality improvement initiatives led to numerous successful audits.    Michelle developed a successful, proactive CMS Mock Audit program, to jointly assist the Plan and PBM in being fully prepared and to foster teamwork and collaboration. Her experience in building FWA programs at the Plan and PBM level has been instrumental to clients looking to add or grow this functionality within their program.

Recently, Michelle managed the Internal & External Audit and corporate Fraud Waste and Abuse programs while helping with Medicare Compliance support for numerous large clients. Michelle is a Certified Fraud Examiner and Certified in Health Compliance and has spoken extensively on FWA and Compliance topics throughout the United States.

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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!