Job DescriptionProvides direction and oversight to the management of Complaints Tracking Module (CTM) complaints. Trends issues and alerts senior Compliance leadership. Prepares analysis which will be used to identify areas for improvement throughout the Medicare organization. Direct interaction with regulators including CMS.
- Review and monitor complaints filed directly with CMS via the CMS Compliant Tracking Module (CTM) in accordance with CMS timelines and guidance.
- Provide direction and oversight to the CTM Analysts.
- Oversee investigations, provide root cause analysis, and appropriate resolution to CTM cases.
- Outreach to beneficiary required.
- Outreach to CMS Regional Offices and Regional Account Manager.
- Ensure supporting evidence is presented and respond to or follow-up with impacted department(s).
- Maintain case files and updated CTM log accordingly.
- Trend CTM cases and report findings to appropriate leadership.
- Schedule routine meetings with direct leadership and provide compliance updates.
- Conduct monthly audits of case files to ensure compliance timeliness and report findings to appropriate leadership.
General Job Information
TitleSupervisor, Complaint Tracking System, Medicare
Job FamilyLegal Group
CountryUnited States of America
FLSA StatusUnited States of America (Exempt)
Recruiting Start Date5/22/2019
Date Requisition Created5/9/2019
EducationA Combination of Education and Work Experience May Be Considered. (Required), Bachelors (Required)
License and Certifications - Required
License and Certifications - Preferred
Other Job Requirements
- This position requires rotational weekend work.
- Requires attention to detail and identification of trends and risk area.
- 2+ years comparable experience.
- Knowledge of all lines of Pharmacy Benefit Management (PBM) and Prescription Drug Plan (PDP) business required.
- 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 internal customer service skills.
- Ability to work independently.
- 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. Every employee must understand, comply and attest to the security responsibilities and security controls unique to their position.
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