Medicare Part D Compliance & Operations Coordinator

Mount Sinai Medical Center of Florida, Inc.; Florida; On-site; USD 55,000 - 85,000; Full time

Job summary

Mount Sinai Medical Center of Florida, Inc. in Hialeah, FL is seeking a Medicare Part D Coordinator to manage Part D activities, PDE reporting, and bid support, ensuring accurate records and regulatory alignment.

The role requires coordination with accounting and clinical teams, tracking licensure, rebates, and reporting to CMS and third parties, with emphasis on compliance and coding accuracy in a complex benefit program.

Qualifications

• Health Care Compliance certification highly preferred.
• Bachelor's Degree is preferred.
• At least 2 years prior experience in a Medicare health plan, Pharmacy Benefit Manager or Part D Actuary.
• Part D program operations and/or compliance experience extremely helpful.
• Experience in compliance and Fraud Waste and Abuse programs; PBM experience preferred.

Responsibilities

• Serves as the point person for all Medicare Part D related activities at Eldercare.
• Supports the annual Part D bid by keeping timely and accurate records of all pharmacy related expenses, bid tracking and works directly with accounting and the bid preparation.
• Responsible for all areas of Pharmacy Drug Event (PDE) reporting and oversight.
• Responsible for drug rebate and manufacturer discount reporting and oversight.
• Responsible for Plan to Plan payment reporting and oversight.
• Acts as the point person for Part D reporting to third party and Medicare (Acumen, HPMS, Pharmastar, Milliman, Palmetto).
• Responsible for the organization’s compliance and Fraud, Waste and Abuse plan including data gathering, evaluation and reporting.
• Tracks licensures, completes/assists with renewal applications to ensure compliance; manages insurance renewals including emergency management plans.
• Conducts compliance audits, prepares reports and communicates findings to Executive Director.
• Responsible for Eldercare Accounts Payable and related administrative tasks; backup for enrollment, claims, network and HR tasks.

Skills

Medicare Part D knowledge

PDE reporting

Compliance programs

Fraud Waste and Abuse experience

Education

Bachelor's Degree

Tools

HPMS

Acumen

Pharmastar

Milliman

Palmetto

Job description

Mount Sinai Medical Center of Florida, Inc. in Hialeah, FL is seeking a Medicare Part D Coordinator to manage Part D activities, PDE reporting, and bid support, ensuring accurate records and regulatory alignment.

The role requires coordination with accounting and clinical teams, tracking licensure, rebates, and reporting to CMS and third parties, with emphasis on compliance and coding accuracy in a complex benefit program.