AmeriHealth Caritas Medicare Program Specialist in Philadelphia, Pennsylvania
Medicare Program Specialist
Location: Philadelphia, PA
Your career starts now. We’re looking for the next generation of health care leaders.
At AmeriHealth Caritas, we’re passionate about helping people get care, stay well and build healthy communities. As one of the nation's leaders in health care solutions, we offer our associates the opportunity to impact the lives of millions of people through our national footprint of products, services and award-winning programs. AmeriHealth Caritas is seeking talented, passionate individuals to join our team. Together we can build healthier communities. If you want to make a difference, we’d like to hear from you.
Headquartered in Philadelphia, AmeriHealth Caritas is a mission-driven organization with more than 30 years of experience. We deliver comprehensive, outcomes-driven care to those who need it most. We offer integrated managed care products, pharmaceutical benefit management and specialty pharmacy services, behavioral health services, and other administrative services. Discover more about us at www.amerihealthcaritas.com .
Under the direction of the Medicare Program Manager, this role serves as a subject matter expert within the Company regarding Medicare rules and works with individual departments to research, identify and address areas of vulnerability related to regulatory compliance. This includes tracking, reviewing and analyzing policies, regulations and compliance requirements that could impact PerformRx's products.
Read, interpret, summarize, CMS Health Plan Management System (HPMS) memos for internal stakeholders and clients
Provide compliance training and oversight of the Medicare (Part D, MMP) reporting process
Investigate potential issues of regulatory and or privacy (HIPAA) non-compliance and coordinate provision of of final report, root cause analysis, and beneficiary impact reports with internal departments as well as downstream entities
Complete monitoring events to determine the level of compliance to newly instituted regulatory procedures and or corrective action plans
Write client bulletins, policies, desktop procedures, and corrective action plan responses.
Support the administration of internal and external audits, CMS Complaint Tracking Module issues, the annual Part D application process, reporting requirements, and data validation audits.
Support the testing and validation of the Medicare Prescription Drug Plan Finder, formulary, marketing materials, and the PerformRx client portal
Document and maintain project plans and status reports as related to the annual Part D implementation process, audits, and other ad hoc initiatives as needed.
Acts as the regulatory lead on new and continuing client implementation activities.
Bachelor’s Degree or 4+ years’ professional work experience at a health plan, pharmacy benefit manager, or state/federal agency
Minimum 1 year of professional work experience in a regulatory compliance, internal audit, or investigation setting, preferably in a health care setting
Minimum 3 years of experience in an office setting
Must possess strong research and analytical skills, as well as excellent verbal and written communication skills
Demonstrated competency in investigating potential errors and evaluating root-cause analyses
Possesses ability to analyze and interpret policy, ability to identify relevance and potential to PerformRx
Ability to deliver information accurately in a fast-paced environment with insight and perspective
Proficiency with MS Office Suite and Internet required
Knowledge of PBM, Medicare (Part D), Corrective Action Plans
EOE Minorities/Females/Protected Veterans/Disabled