Michelle Ford, MHA, CPhT, specializes in Medicare and Medicaid compliance in health plans and PBMs, pharmacy solutions, and operations. Focusing on MAPD and PDP compliance, Michelle has a track record of developing CMS compliant formulary and benefit administration; coverage determination, appeals and grievance; and compliance programs.
Prior to consulting, Michelle was a Medicare claims analyst with a large Pharmacy Benefit Manager (PBM). She currently works with numerous Medicare sponsors - supporting their operations, performing claims review and analysis, coverage determination, appeals, and grievance review and analysis, compliance program reviews, and mock audits.
With a Master of Science degree in Health Care Administration and Health Informatics, Michelle’s education and experience focus on health informatics, EMR, health information and database system design, implementation, and testing as well as reporting and analysis. She also holds a PTCB Pharmacy Technician Certification and has studied project management and risk analysis with the Project Management Institute.