Medicare Plan Operations Coordinator

Mount Sinai Medical Center; Florida; Vor Ort; USD 65.000 - 110.000; Vollzeit

Benefits dieser Stelle

Health benefits

Life insurance

Long-term disability coverage

Retirement plan

Paid time off

Tuition reimbursement

Wellness program

On-site housing for select positions

Zusammenfassung

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.

Qualifikationen

• 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.

Aufgaben

• 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.

Ausbildung

Bachelor's Degree (preferred)

Jobbeschreibung

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.