Medicare Part D Coordinator

Mount Sinai Medical Center of Florida•Hialeah, FL

About The Position

The Medicare Part D Coordinator serves as the point person for all Medicare Part D activities at Eldercare. The role supports the annual Part D bid by maintaining timely and accurate records of pharmacy-related expenses, tracking the bid, and working with accounting and bid preparation. It oversees Pharmacy Drug Event (PDE) reporting, drug rebate and manufacturer discount reporting, Plan-to-Plan payment reporting, and required Part D reporting to third parties and Medicare. The coordinator is responsible for the organization’s compliance and Fraud, Waste and Abuse plan, including gathering, evaluating, and reporting data. The position tracks organizational licenses and assists with renewals, manages insurance renewals and related applications, conducts compliance audits, and reports findings to the Executive Director. It also handles Eldercare accounts payable, provides backup support for enrollment, claims, network, and HR tasks, keeps management informed about projects and issues, completes assignments accurately and on time, adheres to Eldercare’s philosophy and goals, and supports Quality Improvement initiatives.

Requirements

At least 2 years of prior experience in a Medicare health plan, Pharmacy Benefit Manager, or Part D Actuary.

Nice To Haves

Health Care Compliance certification is highly preferred.
A bachelor’s degree is preferred.
Prior experience in Part D program operations and/or compliance is extremely helpful.
Experience in compliance and Fraud, Waste and Abuse programs is preferred.
Experience working with a pharmacy benefit manager is preferred.

Responsibilities

Serve as the point person for all Medicare Part D activities at Eldercare.
Support the annual Part D bid by maintaining accurate, timely records of pharmacy-related expenses, tracking the bid, and working with accounting and bid preparation.
Oversee Pharmacy Drug Event (PDE) reporting.
Oversee drug rebate and manufacturer discount reporting.
Oversee Plan-to-Plan payment reporting.
Manage required Part D reporting to third parties and Medicare, including Acumen, HPMS, Pharmastar, Milliman, and Palmetto.
Manage the organization’s compliance and Fraud, Waste and Abuse plan, including data gathering, evaluation, and reporting.
Track organizational licenses and complete or assist with renewal applications to maintain compliance.
Manage insurance renewals, including emergency management plans, and complete or assist with renewal applications to maintain coverage.
Conduct compliance audits, prepare reports, and communicate findings to the Executive Director.
Manage Eldercare accounts payable, accurately completing check requests and attaching invoices for management approval.
Provide backup support for enrollment, claims, network, and HR-related tasks.
Communicate regularly with management about ongoing projects and issues.
Complete assignments accurately and in a timely manner.
Adhere to Eldercare’s philosophy and goals.
Participate in and support Quality Improvement initiatives.