AmeriHealth Caritas Medicare Program Specialist in Philadelphia, Pennsylvania

Medicare Program Specialist

Location: Philadelphia, PA

Telecommuter?: No

ID**: 14436

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 .


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