Responsible for providing subject matter expertise on Medicare Part C in order to effectively support our clients.

Essential Functions:

• Subject matter expertise in an operational function of Medicare Part C
• Ability to review, interpret and implement state and federal guidance
• Perform CMS mock audits in CPE, ODAG and SNP-MOC to confirm compliance with guidance.
• Monitors the implementation of the corrective action plans and ensures that the result of the action plans are compliant.
• Mentor and drive work product based on the project
• Oversee and administer ongoing monitoring program(s) based on guidance
• Updates policies, procedures and Audit Work Plan based as needed.
• Adhere to established corporate policies and procedures
• Perform other duties, as necessary, to meet corporate objectives
• Travel as required

• Bachelor’s degree and a minimum of ten (10) years government, health care, pharmacy benefit management, compliance or quality profession (equivalent combination of education and experience considered.)
• Must have strong Microsoft Office Suite skills. Advanced skills in Word, Excel, Access and PowerPoint required
• Experience with Medicare and/or Medicaid standards required
• Advanced degree or certification in audit, pharmacy or compliance discipline preferred
• Must have strong verbal and written communication skills.
• Individual should be detail oriented with strong organization, prioritization and analytical skills with the ability to work independently.
• Must work well under tight timelines and adapt quickly to change in a fast-paced, team-oriented, and high-growth environment.