GENERAL SUMMARY
Works cross-functionally to load and validate the Medicare Advantage (MA-PD) and/or Medicare Part D Prescription Drug Plan (PDP) bid pricing tool module in association with the annual bid filing. Responsible for the development, validation, and fulfillment of CMS required annual materials and mailers as they relate to MA-PD and/or PDP products. Serves as the MA-PD and/or PDP plan benefit package internal subject matter expert. Two positions available.
ESSENTIAL RESPONSIBILITIES
- Works in conjunction with the Actuarial team to for validate source documents created for the annual bid submission.
- Works cross-functionally to upload plan benefits for each MA-PD and/or PDP product bid submission. Validates logged benefits and any associated premiums against the bid pricing tool.
- Provides guidance to Medicare personnel relating to benefit bid upload. Validates logged benefits and any associated premiums against the bid pricing tool.
- In accordance with regulatory requirements, create schemas, configuration files, logic, etc. that produce health plan materials including Annual Notification of Change, Evidence of Coverage, Summary of Benefits, Formulary(s), Low-Income Subsidy communications, translated materials, web postings, etc.
- Implements internal quality control measures to validate constructed health plan materials, prior to CMS submission.
- Initiates the print production fulfillment process of CMS required annual materials and mailings, while being sensitive to the timelines of all parties involved. Monitors production, incorporating quality assurance measures which validate accuracy throughout the process. Coordinates cross-functionally with internal business units and external vendors in order to meet regulatory requirements and internal business needs.
- Maintains a repository of final product materials, including fulfillment dates.
- Understands business processes, systems, tools, regulations, and structure and how they interrelate to provide products and services that create value for Coventry customers and key stakeholders.
- Controls expenses while meeting operational, financial, and service requirements.
- Performs other duties as required.
Qualifications:
JOB SPECIFICATIONS
- Bachelor’s degree or equivalent experience.
- Requires previous (3 to 5 years) experience in government programs.
- Requires in-depth knowledge of regulated lines of business and managed care policy and direction.
- Strong communication and negotiation skills.
- Ability to perform analysis and legal research to identify and clarify issues.
- Demonstrated problem solver and team player.
- Excellent interpersonnel and leadership skills.
- Effective communication and presentation skills.
- Ability to effectively coordinate multiple projects.
- Proficiency with desktop software applications such as e-mail, Word and Excel.
Coventry Health Care is an Affirmative Action/Equal Opportunity Employer, and we are committed to building a talented and divrse team.
Job: Professionals
Primary Location: King of Prussia, PA, US
Organization: 37910 - Medicare Part D Overhead
Schedule: Full-time
Job Posting: 2013-01-08 00:00:00.0
Job ID: 1310081