Compliance Specialist

Utah, Arizona, Virginia, Connecticut, Florida, Missouri, Maryland

Job Description

This position supports management by providing Complaints Tracking Module (CTM) adjudication and beneficiary protection as prescribed by CMS.

Employee must sit in a Magellan office.
  • Reviews and investigates complaints filed directly with CMS via the CMS Compliant Tracking Module (CTM) while remaining compliant with CMS timelines and guidance at all times.
  • Conducts investigations, provides root cause analysis, and recommends appropriate resolutions.
  • Outreach to beneficiary required.
  • Maintains case files and updates CTM log accordingly.

General Job Information

Title

Compliance Specialist

Grade

19

Job Family

Legal Group

Country

United States of America

FLSA Status

United States of America (Non-Exempt)

Recruiting Start Date

2/6/2019

Date Requisition Created

1/31/2019

Minimum Qualifications

Education

A Combination of Education and Work Experience May Be Considered. (Required), Bachelors (Required)

License and Certifications - Required

CPT/LPT/PTCB/RPT, Pharmacy Technician, State Requirements - Pharmacy

License and Certifications - Preferred

Other Job Requirements

Responsibilities

  • This position requires rotational weekend work.
  • Requires attention to detail and identification of trends and risk area.
  • Familiarity with all lines of Pharmacy Benefit Management (PBM) and Prescription Drug Plan (PDP) business.
  • Previous escalation resolution experience.
  • Excellent verbal and written communication and analytical skills.
  • Previous experience in data entry, customer service and claims.
  • Ability to identify, trend and communicate risk effectively.
  • Outstanding customer service skills.
  • Experience in Medicare compliance field or related area.
  • Familiarity with standard concepts, practices and procedures within Healthcare industry.
  • Familiarity with Federal and State regulations for Medicare.
  • Working knowledge of Microsoft Office Product Suite.

Magellan Health Services is proud to be an Equal Opportunity Employer and a Tobacco-free workplace. EOE/M/F/Vet/Disabled

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