Medicare Business Operations Specialist
Company: Magellan Health
Posted on: September 12, 2021
This position supports the Medicare Part D Plan(s) to ensure
operational and IT business and financial management activities are
aligned with department strategies, assisting with operations
reviews and special assignments to support the planning and
coordination of major endeavors. This includes supporting all
business management processes in partnership with the appropriate
process owners including strategic and operational planning,
communications, reporting, financial management, and workplace
management. Demonstrates knowledge of Medicare Part D regulations
and operational monitoring activities to effectively perform duties
that support the Prescription Drug Plan (PDP) and Employer Group
Waiver Plan’s (EGWP) compliance with CMS requirements. Manages the
implementation of Medicare Part D operational policies and
procedures. Responsible for tracking Medicare requirements and
ensuring departments continue to meet CMS expectations to deliver
optimal outcomes for beneficiaries.
- Reviews and interprets policy and regulatory documents to
identify the impact on operations.
- Monitors HPMS Memos/ CMS guidance for operational changes and
develops timelines/work plans to implement changes. Provides
support through the planning and execution of these projects.
Support may include developing business requirements, establishing
deadlines, assigning resources/responsibilities and monitoring and
summarizing progress of projects. Prepares reports for upper
management regarding status of project.
- Identify Medicare product benefits and prepare and manage the
annual bid process and validation for the Medicare plan.
Manage multiple workgroups with all levels of management for
development of the bid. Coordinate with Legal, Actuarial,
Compliance, and other operational areas.
- Provides Medicare Part D subject matter expertise in response
to day-to-day business issues.
- Creates and executes project work plans and revises as
appropriate to meet changing needs and requirements.
- Coordinate annual readiness checklist process for CMS
- Provide general support, collect, and prepare information and
data for the facilitation of standard recurring meetings,
such as tactical, strategic and operations
- Document and track action items for centralized reporting for
dashboard of operational metrics.
- Track, review, analyze project and resource expenditures.
- Provide support to operations roles as required.
- Support Medicare Plan(s) in downloading and submitting data to
HPMS (Health Plan Management System).
- Ensures adherenceto CMS provided timelines and ensures
timeliness and accuracy of compliance activities.
- Reviews data to evaluate KPIs.
- Acts as a liaison between departments to manage large-scale
projects and implementations.
- Manages day-to-day operational aspects of a project, including
meeting facilitation and documentation.
- Provides status reporting to stakeholders on a regular basis.
Apprises management of issues requiring resolution in
order to maintain progress on a timely basis.
- Provide ad hoc analyses and/or research issues of
non-compliance as requested by management.
PBM operations experience preferred.
- Minimum of 5 years of Part D operations experience.
- Knowledge of Pharmacy Benefit Manager (PBM) basic structure and
- Understanding of CMS policies related to Medicare Part D.
- Ability to analyze Federal and State statutes and regulations
for operational implementation.
- Excellent interpersonal skills necessary to handle sensitive
and confidential information, and to interact with a
diverse patient population, providers and staff.
- Strong sense of professionalism to allow for interactions with
Sr. Management, and clients.
- Strong PC and software application skills, including all
aspects of Microsoft Office.
- Requires a strong sense of time management and can interpret
and help operationalize CMS regulation to remain compliant.
- Experience with data entry.
- Ability to work collaboratively with multiple teams
- Excellent administrative/organizational skills; advanced
analytical ability required in order to gather and interpret data,
and resolve moderately complex problems.
- Excellent leadership skills, including the ability to
prioritize, problem-solve and multi-task in a fast-paced
- Requires reinforcing quality and customer service standards;
analyzing and resolving quality and customer service
problems; identifying trends, recommending process and procedural
Medicare Business Operations Specialist
Medicare Part D (MedD), PBM (Pharmacy Benefit Management)
A Combination of Education and Work Experience May Be Considered.
(Required), Bachelors (Required)
Certifications - Required
Certifications - Preferred
Magellan Health, Inc. is proud to be an Equal Opportunity
Employer and a Tobacco-free workplace. EOE/M/F/Vet/Disabled.
Every employee must understand, comply with and attest to the
security responsibilities and security controls unique to their
position; and comply with all applicable legal, regulatory, and
contractual requirements and internal policies and procedures.
Keywords: Magellan Health, West Valley City , Medicare Business Operations Specialist, Other , Herriman, Utah
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