Remote Part D Claims & Eligibility Specialist

InnovAge Holding Corp.; Denver (CO); A distancia; USD 33.000 - 41.000; Jornada completa

Ventajas ofrecidas por este puesto de trabajo

Medical/dental/vision insurance

401(k) with company match

Paid time off

Life insurance

Descripción de la vacante

InnovAge Holding Corp. is seeking a Part D Claims Eligibility Specialist to support Part D and Part A claim workflows from a remote setting. The role emphasizes accuracy, data integrity, and collaboration with Medicare/Medicaid, finance, and billing teams to ensure compliant billing per CMS guidelines.

You will reconcile PDE data, monitor reporting, and stay updated on Medicare Part D regulations while supporting patient plan eligibility and enrollment workflows.

Formación

• 3+ years working with medical and/or pharmacy claims.
• Advanced knowledge of medication names, dosages, indications, and routes of administration.
• Experience navigating EMR and interpreting EMR data.
• Advanced Excel skills to manage large data sets (formulas, pivots, reports).

Responsabilidades

• Reconcile and manage Part A claims and stays.
• Perform Part D compliance tasks (B vs D, ESRD, Medical Necessity).
• Download and review Part D and PBM reports; take action.
• Review CMS reports; take necessary actions.
• Reconcile rejected claims with pharmacies and PBM.
• Assist in PDE data reconciliation and submission to CMS.
• Summarize PDE progress and prepare PDE submissions.
• Stay current on Part D guidelines and Medicare/Medicaid requirements.
• Coordinate with Medicare, Medicaid, and finance/billing teams.
• Manage provider credentials for PBM and contracted pharmacies.

Conocimientos

Medical/pharmacy claims

Advanced Excel

EMR navigation

Attention to detail

Independent work

Communication

Educación

Associate’s degree or equivalent

Bachelor’s degree (preferred)

Herramientas

EPIC EMR

Excel

Descripción del empleo

InnovAge Holding Corp. is seeking a Part D Claims Eligibility Specialist to support Part D and Part A claim workflows from a remote setting. The role emphasizes accuracy, data integrity, and collaboration with Medicare/Medicaid, finance, and billing teams to ensure compliant billing per CMS guidelines.

You will reconcile PDE data, monitor reporting, and stay updated on Medicare Part D regulations while supporting patient plan eligibility and enrollment workflows.