AFortierResume201512f

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 25 years of experience in the industry and a Board member
of the Health Care Association Federal Credit Union for ten years. Managed 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, Blue Cross and
Blue Shield of Illinois, Montana, New Mexico, Oklahoma and Texas.
EXPERIENCE Health Care Service Corporation Chicago, Illinois 2006 to December 2015
Senior Manager, Legislative & Regulatory Implementation Office 2013 to December 2015
• 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 to support Administrative
Simplification Operating Rules for Eligibility and Benefits and Electronic Funds Transfer and
Electronic Remittance Advice, Health Plan Identification, Meaningful Access, and others.
• Created business impact assessments and responses to 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.
Senior Market Strategy Consultant, Product Development 2007 to 2010
• Managed Illinois Standard Prepackaged Products 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 and submission to CMS, which was approved.
• Directed training development and delivery to support MA PFFS implementation to over 200 Sales,
Account Management, Account Set-up, Actuary, Underwriting and Internal Training staff.
• Coordinated development and participated in presentations of HCSC’s MA PFFS product to four
major national employer groups.
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Anthony W. Fortier
_____________________________________________________________________________________________
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Anthony W. Fortier
_____________________________________________________________________________________________
Senior Market Strategy Consultant, Consumer Markets 2006 to 2007
• Conducted an Over 65 lapse survey and reported results to senior management.
• Contributed to an evaluation, analysis and presentation associated with the infrastructure of a
subsidiary, Hallmark (Convergence), identifying substantial systems enhancements and requiring
considerable investment support. Changes were eventually implemented; awarded a bonus for
efforts.
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 for 10 Blue Plans.
• Supervised legal and BlueCard review of marketing materials for MA PPO products to support Blue
platform to deliver this product to national employer groups.
• Created a web board to facilitate communications of government requirements for developing and
implementing a regional Medicare Advantage product for the Blue system.
• Selected to serve as advisor to CMS for new Senior Market government programs.
• 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.
• Designed presentations and educational materials to support subject matter experts in resolving
national inconsistencies for processing Medicare-related claims, improving claims processing time.
• Designed and implemented a national customer service call center to provide 24/7 hospital and
doctor information to members.
HMO-USA Sales and Network Management Consultant 1994 to 1996
• Produced over 50 national account proposals to national employer groups, brokers and consultants.
• Sold 15 groups which represented more than 100,000 lives.
• Governed renewal and resolution of ongoing issues for 25 HMO-USA groups.
Supervisor/Billing Manager 1989 to 1994
• Directed a team of 10 to manage billing process and provide training and assistance for HMO-USA’s
Operations Service Center.
• Provided guidance on the product development and implementation of new billing services extended
to more than 30 national employer groups in support of HMO-USA Sales and Support teams.
Financial Analyst 1986 to 1989
• Responsible for identification, collection and tracking of accruals for the organization.
• Monitored and resolved Accounts Payable and Accounts Receivable inquiries.
• Supported the budget process.
INTERESTS & Culture Committee Chair, Pride Alliance Business Resource Group for HCSC
ACTIVITES Member, Design Institute for Fighting Aids
Board Member, Health Care Association Federal Credit Union
Motivational Speaker for Chicago-area youth
EDUCATION DePaul University Chicago, Illinois
School for New Learning – Bachelor of Arts degree in Business and Product Development, 2002
Lake Forest School of Management Lake Forest, Illinois
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Anthony W. Fortier
_____________________________________________________________________________________________
Master of Business Administration coursework, 2008 - 2010. Maintained 4.0 GPA while working full time.
6d1c7498b75c-160101134019.doc

AFortierResume201512f

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