Job description

• Bachelor’s degree in Business Administration, Healthcare Administration, Finance or related field.
• 4 years of relevant work experience required with at least 2 years directly involved in Medicare Advantage or Part D data collection and data analytic activities.
• Working knowledge of Medicare Advantage Part C and Part D Reporting Requirements including CMS Audit Protocols.
• High level familiarity with compliance risk areas relating to Medicare insurance industry.
• Proficiency with MS Office suite, HPMS and Acumen

PRIMARY DUTIES AND RESPONSIBILITIES:

• Collects, analyzes, interprets and documents information in preparing effective and timely audit reports, including activities associated with preparing for audits by independent third parties or Centers for Medicare and Medicaid Services (CMS) site visit.
• Maintains knowledge of industry regulatory guideline changes and how they impact health plan operational and audit processes.
• Strong planning, organization, and problem-solving skills, including the ability to prioritize tasks across operational departments, including Finance and FDRs. Ability to identify actionable improvement opportunities and convey analytic results.
• Networks with and assists business owners regarding regulations specific to their data collection and CMS reporting submissions
• Assists with preparation of Annual Audit Program and operational audit oversight.

Serves as a subject matter expert regarding claims, appeals and grievances and PBM data trends. Ability to identify operational defect root causes, actionable improvement opportunities and convey analytic results.

Job Type: Full-time

Benefits:

• 401(k)
• 401(k) matching
• Dental insurance
• Employee assistance program
• Flexible spending account
• Health insurance
• Health savings account
• Life insurance
• Paid time off
• Tuition reimbursement
• Vision insurance

Schedule:

• Monday to Friday

Work Location: One location

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