Susan Herman is a Senior Consultant with BluePeak Advisors, where she works with Medicare Advantage (MA) health plans and Pharmacy Benefit Management (PBM) companies on compliance and operational issues for Parts C and D. Prior to consulting Susan worked in the managed care industry as a federal regulator with the CMS San Francisco Regional Office from 1991 to 2012. She has a wealth of experience in the oversight of Medicare Advantage and Prescription Drug plans. Susan was an Account Manager with front line responsibility for a variety of contracting organizations including the largest Medicare Advantage contractor which operated over 100 plans in all 50 states. In 2008 Susan took a management position as Branch Manager of the Managed Care division and led a team of 14 account managers that were responsible for the oversight of 30+ Medicare Advantage organizations.
Susan has led and participated in numerous audit activities for CMS. During her tenure with CMS she was a leader in the development of audit protocols and strategies to implement risk based oversight of contracting organizations.
Susan is a subject matter expert in the areas of Compliance Program Effectiveness and Organization Determinations Appeals and Grievance (ODAG) and has worked with many clients to perform mock audits, validation audits and operational assessments. She has presented at numerous CMS and industry conferences and continues to be industry expert in these areas.