Medicare Plan Coordinator

Mount Sinai Medical Center; Florida; Presencial; USD 65.000 - 110.000; Jornada completa

Ventajas ofrecidas por este puesto de trabajo

Health benefits

Life insurance

Long-term disability coverage

Retirement plan

Paid time off

Tuition reimbursement

Wellness program

On-site housing for select positions

Descripción de la vacante

Mount Sinai Medical Center of Florida, Inc. is seeking a compliance-focused professional to oversee Medicare Part D activities for Eldercare. The role involves bid support, PDE reporting, rebates, and third-party/Medicare reporting, ensuring regulatory compliance across the program.

Responsibilities include maintaining licensure, renewals, audits, and coordination with management on ongoing projects. Experience with Part D operations and Fraud, Waste and Abuse programs is highly valued.

Formación

• Health Care Compliance certification highly preferred.
• Bachelors Degree is preferred.
• At least 2 years prior experience in a Medicare health plan, Pharmacy Benefit Manager or Part D Actuary.
• Prior experience in Part D program operations and/or compliance is extremely helpful.
• Experience in compliance and Fraud Waste and Abuse programs as well as experience working with a pharmacy benefit manager are preferred.

Responsabilidades

• 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.
• Serves as the point person for all Part D required reporting to third party and Medicare (Acumen, HPMS, Pharmastar, Milliman, Palmetto etc.).
• Responsible for the organization’s compliance and Fraud, Waste and Abuse plan including data gathering, evaluation and reporting.
• Tracks all organizations licensures, completes/assists with all renewal applications to ensure compliance.
• Responsible for insurance renewals including emergency management plans, completes/assists with all renewal applications to ensure coverage remains active.
• Conducts compliance audits, prepares reports and communicates findings to Executive Director.
• Responsible for all Eldercare Accounts Payable including accurately completing check requests and attaching invoices for management approval.
• Serves as a backup for enrollment, claims, network and HR related tasks.
• Communicates with management regularly to keep them abreast of ongoing projects/issues.
• Completes assignments in an accurate and timely manner.
• Knows and adheres to philosophy and goals of Eldercare.
• Participates in and supports Quality Improvement initiatives.

Educación

Bachelor's Degree (preferred)

Descripción del empleo

As Mount Sinai grows, so does our legacy in high-quality health care.Since 1949, Mount Sinai Medical Center has remained committed to providing access to its diverse community. In delivering an unmatched level of clinical expertise, our medical center is committed to recruiting and training top healthcare workers from across the country. We offer the latest in advanced medicine, technology, and comfort in 12 facilities across Miami-Dade (including our 674-bed main campus facility) and Monroe Counties, with 38 medical services, including cancer care, 24/7 emergency care, orthopedics, cardiovascular care, and more. Mount Sinai takes pride in being South Florida's largest private independent not-for-profit hospital, dedicated to continuing the training of the next generation of medical pioneers.Culture of Caring: The Sinai WayOur hardworking, tight-knit community of more than 4,000 dedicated employees fosters an environment of care and compassion. Each member plays a vital role in our collective mission to deliver excellent healthcare through innovation, education, and research. At Mount Sinai, we take pride in our achievements, aiming to be a beacon of quality healthcare in South Florida. We welcome all healthcare professionals to join our thriving community and contribute to our pursuit for clinical excellence.Department:Job Description Summary:Position ResponsibilitiesServes 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.Serves as the point person for all Part D required reporting to third party and Medicare (Acumen, HPMS, Pharmastar, Milliman, Palmetto etc.).Responsible for the organization’s compliance and Fraud, Waste and Abuse plan including data gathering, evaluation and reporting.Tracks all organizations licensures, completes/assists with all renewal applications to ensure compliance.Responsible for insurance renewals including emergency management plans, completes/assists with all renewal applications to ensure coverage remains active.Conducts compliance audits, prepares reports and communicates findings to Executive Director.Responsible for all Eldercare Accounts Payable including accurately completing check requests and attaching invoices for management approval.Serves as a backup for enrollment, claims, network and HR related tasks.Communicates with management regularly to keep them abreast of ongoing projects/issues.Completes assignments in an accurate and timely manner.Knows and adheres to philosophy and goals of Eldercare.Participates in and supports Quality Improvement initiatives.QualificationsLicense/Registration/CertificationHealth Care Compliance certification highly preferred.EducationBachelors Degree is preferred.ExperienceAt least 2 years prior experience in a Medicare health plan, Pharmacy Benefit Manager or Part D Actuary. Prior experience in Part D program operations and/or compliance is extremely helpful. Experience in compliance and Fraud Waste and Abuse programs as well as experience working with a pharmacy benefit manager are preferred.Benefits:We believe in the physical and mental well-being of our employees and are committed to offering comprehensive benefits that fit their personal needs:Health benefitsLife insuranceLong-term disability coverageHealthcare spending accountsRetirement planPaid time offPet InsuranceTuition reimbursementEmployee assistance programWellness programOn-site housing for select positions and more!Degree Requirements:Certification: