Compliance Specialist

United States

Job Description

SUPERVISOR, COMPLIANCE AND AUDIT, MEDICARE

General Job Information

Title

Compliance Specialist

Grade

23

Job Family

Pharmacy Group

Country

United States of America

FLSA Status

United States of America (Exempt)

Recruiting Start Date

10/9/2019

Date Requisition Created

10/9/2019

Work Experience

Medicare Part D (MedD), PBM (Pharmacy Benefit Management)

Education

Bachelors

License and Certifications - Required

License and Certifications - Preferred

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

Other Job Requirements

Responsibilities

  • 5+ years in Medicare Part D, Medicare Advantage, and/or managed Medicaid.
  • Solid understanding of CMS (Centers for Medicare and Medicaid).
  • Solid understanding of HPMS System and STAR ratings.
  • Ability to collaborate with many functional areas of a large national organization.  Knowledge of HIPAA.
  • Proficient with MS-Office Word, Excel, PowerPoint, etc.
  • 3+ years of experience in compliance-related matters in the health care industry.
  • Experience working for a Managed Care Company or other health related organization. 
  • Knowledge of group health, managed care claims and/or pharmacy claims payment processes.

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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