Medicare Part D Compliance Specialist

Mount Sinai Medical Center; Florida; On-site; USD 60,000 - 85,000; Full time

Benefits offered by this job

Health benefits

Life insurance

Long-term disability coverage

Retirement plan

Paid time off

Tuition reimbursement

Employee assistance program

Wellness program

On-site housing for select positions

Job summary

Mount Sinai Medical Center is seeking a Medicare Part D Compliance Specialist at Eldercare in Miami. You will serve as the main point of contact for Part D activities, manage PDE and other reporting, and oversee rebates and plan-to-plan payments to ensure program compliance.

Responsibilities include annual bid support, licensure tracking, renewals, and coordination with accounting and third-party systems. Bachelor’s degree and healthcare compliance experience preferred for this role.

Qualifications

• 2+ years in a Medicare health plan, Pharmacy Benefit Manager, or Part D Actuary.
• Experience in Part D program operations and/or compliance is helpful.
• Experience with Fraud, Waste and Abuse programs is preferred.

Responsibilities

• Serve as the point person for all Medicare Part D related activities at Eldercare.
• Maintain timely and accurate records of all pharmacy expenses and bid tracking.
• Oversee PDE reporting and oversight; manage drug rebates and manufacturer discounts.
• Handle Plan to Plan payment reporting and reporting to third parties (Acumen, HPMS, Pharmastar, Milliman, Palmetto).
• Support compliance efforts, including Fraud, Waste and Abuse data gathering and reporting.
• Track licensures and renewals to ensure ongoing compliance and active coverage.
• Backup enrollment, claims, network and HR tasks as needed.
• Communicate project status and issues to management; participate in Quality Improvement initiatives.

Skills

Medicare Part D knowledge

Regulatory compliance

PDE reporting

Fraud, Waste and Abuse

Pharmacy Benefits reporting

Education

Bachelor's Degree

Health Care Compliance certification preferred

Tools

Acumen

HPMS

Pharmastar

Milliman

Job description

Mount Sinai Medical Center is seeking a Medicare Part D Compliance Specialist at Eldercare in Miami. You will serve as the main point of contact for Part D activities, manage PDE and other reporting, and oversee rebates and plan-to-plan payments to ensure program compliance.

Responsibilities include annual bid support, licensure tracking, renewals, and coordination with accounting and third-party systems. Bachelor’s degree and healthcare compliance experience preferred for this role.