Medicare Plan Coordinator — Compliance & PDE Lead

CMP01 Mount Sinai Medical Center of Florida, Inc.; Town of Florida (NY); On-site; USD 75,000 - 110,000; Full time

Benefits offered by this job

Health benefits

Life insurance

Long-term disability

Healthcare spending accounts

Retirement plan

Paid time off

Pet Insurance

Tuition reimbursement

Employee assistance program

Wellness program

On-site housing

Job summary

Mount Sinai Medical Center is seeking a Medicare Part D Compliance Specialist to oversee Part D activities at Eldercare, including PDE reporting, bid support, and compliance programs. The role requires experience with Medicare health plans or PBMs and a strong background in regulatory compliance.

The ideal candidate has at least 2 years in Part D-related operations, a health care compliance certification, and a Bachelor's degree.

Qualifications

• License/Registration/Certification Health Care Compliance certification highly preferred.
• Education Bachelor's Degree is preferred.
• Experience At least 2 years prior experience in a Medicare health plan, Pharmacy Benefit Manager or Part D Actuary.
• 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.

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.
• 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.

Skills

Medicare Part D

Pharmacy compliance

PDE reporting

Education

Bachelor's Degree

Job description

Mount Sinai Medical Center is seeking a Medicare Part D Compliance Specialist to oversee Part D activities at Eldercare, including PDE reporting, bid support, and compliance programs. The role requires experience with Medicare health plans or PBMs and a strong background in regulatory compliance.

The ideal candidate has at least 2 years in Part D-related operations, a health care compliance certification, and a Bachelor's degree.