1. Anthony W. Fortier
3750 N. Lake Shore Drive, Unit #10B, Chicago, IL 60613, tel. (773) 271-3996
AWFortier3750@gmail.com
_____________________________________________________________________________________________
Health insurance professional with over 20 years of experience in the industry. Managed an Analyst
team responsible for regulatory implementation of over 50 Patient Protection and Affordable Care Act
(ACA) and Health Insurance Portability and Accountability Act (HIPAA) regulations for the third
largest health insurer in the nation. Strong leadership skills with a record of process improvements
that resulted in millions of dollars saved and should ensure compliance for Health Care Service
Corporation (HCSC) which consists of Blue Cross and Blue Shield of IL, MT, NM, OK and TX.
EXPERIENCE Health Care Service Corporation Chicago, Illinois 2006 to Present
Senior Manager, Legislative & Regulatory Implementation Office 2013 to Present
• Manage staff of nine Consultants in creating initial regulatory documents used to implement federal
regulations
• Incorporated process that reduced the time to create Business Regulatory Requirements Documents
of multi-facetted regulations by more than seventy five percent (e.g., 2015 and 2016 Notice of Benefit
Payment Parameters, HIPAA Omnibus Rule and Program Integrity Rule)
• Responsible for over 50 published regulations related to ACA and HIPAA
• Manage two Specialists who manage the Medicare Secondary Payer (MSP) reporting that
administers coordination of benefits between employer groups and the Centers for Medicare and
Medicaid Services (CMS)
• Conducted organization-wide assessment of the MSP process to ensure compliance with Group
Health Plan regulations established by the government
• Reduced MSP errors by 22% as a result of implementing enhancements identified from assessment
• Accountable for Senior Manager responsible for the management of Extraterritorial (ET) and National
Carrier state mandates of which there are 35 states and includes all HCSC states except Illinois
• Developed a transition approach for ET that did not require additional staff as a result of a retirement
• Initiated an assessment to support the organization’s oversight of ET to ensure compliance
Analyst Lead, Legislative & Regulatory Implementation Office 2010 to 2013
• Developed more than 12 Business Impact Analysis documents; Administrative Simplification
Operating Rules for Eligibility and Benefits and Electronic Funds Transfer and Electronic
Remittance Advice, Health Plan Identification, Meaningful Access, and others.
• Creates business impact assessments for government agency request for comments, notice of
proposed ruling making and interim final rules
• Primary liaison for Grandfathering and Administrative Simplification efforts of ACA and HIPAA
• Researched and developed approach to support audit requirements for Medical Loss Ratio (MLR)
Senior Market Strategy Consultant, Product Development 2007 to 2010
• Managed Illinois Standard Prepackaged Products (IL SPP) and implemented 368 new ACA compliant
plans to support individual and small group markets
• Identified and resolved issues associated with claims, eligibility and sales applications.
• Researched and implemented Student Health pilot product that recognized close to 2,000 contracts
and over 1.3 million dollars of premium in the first year
• Managed Product Development efforts and contracted with third-party administrator to support
Medicare Advantage Private Fee-for-Service (MA PFFS) application
• Completed MA PFFS application; directed training development and delivery to support MA PFFS
implementation
• to CMS which was approved
• Directed Training development and delivery to support MA PFFS implementation
• Coordinated development and participated in presentation of HCSC’s MA PFFS product to national
employer groups
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2. Anthony W. Fortier
3750 N. Lake Shore Drive, Unit #10B, Chicago, IL 60613, tel. (773) 271-3996
AWFortier3750@gmail.com
_____________________________________________________________________________________________
Senior Market Strategy Consultant, Consumer Markets 2006 to 2007
• Responsible for various projects associated with individual lines of business
• Conducted an Over 65 lapse survey and reported results to upper management
• Contributed to an evaluation, analysis and presentation associated with the infrastructure of a
subsidiary, Hallmark (Convergence)
Blue Cross Blue Shield Association Chicago, Illinois 1986 to 2006
Senior Consultant, BlueCard Product Development 1996 to 2006
• Managed the inter-Plan implementation of a regional Medicare Advantage PPO (MA PPO) product
• Developed business requirements for the day-to-day inter-Plan operations of a MA PPO product in
support of a potential system-wide implementation of this product
• Supervised the legal and BlueCard review of marketing materials for MA PPO products
• Created a web board to facilitate communications of government requirements for developing and
implementing a regional Medicare Advantage product for the Blue system
• Lead Medicare Operations and Implementation and served as a Blue advisor to CMS for new Senior
Market government programs as a result of extensive industry experience
• Developed and implemented business requirements for Medicare–related claims processes through
existing platforms supported by Blue Cross Blue Shield Association for all Blue Plans
• Facilitated regional training sessions for 40+ healthcare plans on systems enhancements to support
Medicare business for the Blue system of Plans
• Designed presentations and educational materials to support Plan subject matter experts in resolving
national inconsistencies for processing Medicare-related claims
• Executed a process to streamline the CMS crossover consolidation process for 40+ Blue healthcare
plans by developing a project plan, coordinating and facilitating workgroup meetings, and serving as
point person for problem resolution
• Designed and implemented a national customer service call center to provide hospital and doctor
information to insurance members on a 24 hours/day, 7 days/week basis.
• Established criteria for vendors in support of a Statement of Work, provider data and pilot plans.
• Marketed service that resulted in the implementation of a call center that supports 40+ Blue Cross
and Blue Shield Licensees and receives an average of 116,000 calls a month
HMO-USA Sales and Network Management Consultant 1994 to 1996
• Produced national account proposals to national employer groups, brokers and consultants
• Sold 15 groups with more than 100,000 lives in the first year
• Managed the renewal and resolution of ongoing issues for 25 HMO-USA groups
Supervisor/Billing Manager 1989 to 1994
• Directed a team of ten individuals to manage the billing process and provide training and assistance
for the sales of HMO-USA’s Operations Service Center
• Provided guidance on the product development and implementation of new billing services extended
to national employer groups in support of HMO-USA Sales and Support teams
INTERESTS & Design Institute for Fighting Aids; Health Care Association Federal Credit Union Board of
ACTIVITES Directors; Chicago Area Youth Motivation Speaker; Lyric Opera Backstage Tours Guides
EDUCATION Lake Forest School of Management (Lake Forest, Illinois)
Master of Business Administration (4.0 G.P.A. with two years completed)
DePaul University (Chicago, Illinois)
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3. Anthony W. Fortier
3750 N. Lake Shore Drive, Unit #10B, Chicago, IL 60613, tel. (773) 271-3996
AWFortier3750@gmail.com
_____________________________________________________________________________________________
School for New Learning - Business and Product Development (Bachelor of Arts)
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