ConsultNet Technology Services and Solutions
Director, Medicare and Data Compliance
ConsultNet Technology Services and Solutions, North Kingstown, Rhode Island, us, 02852
Overview
Considering applying for this job Do not delay, scroll down and make your application as soon as possible to avoid missing out. Join to apply for the
Director, Medicare and Data Compliance
role at
ConsultNet Technology Services and Solutions .
The Director, Medicare and Data Compliance will be responsible for analyzing and interpreting pharmacy data related to Medicare programs, specifically focusing on CMS Direct Subsidy, PDE, and MMR. The role involves working with large datasets, ensuring compliance with CMS regulations, and providing insights to improve healthcare outcomes and financial performance. They will work closely with other team members to collaborate and support team processes. They will be responsible for leading our compliance reporting efforts and partnering with key business stakeholders.
KEY RESPONSIBILITIES
Analyze Medicare data, including PDE submissions, MMR reports, and CMS Direct Subsidy allocations
Work with Finance and Account Management to project yearly Medicare changes
Ensure data accuracy and compliance with CMS guidelines and reporting requirements
Own and maintain reporting processes needed to support organization compliance requirements
Maintain and manage large datasets related to Medicare Part D and other relevant programs
Monitor performance through tracking trends and identifying discrepancies in subsidy allocations and prescription drug events
Work with cross-functional teams, including finance, IT, Account Management, and Compliance to optimize Medicare data usage
Lead process improvement through developing strategies to enhance data collection, reporting, and analysis efficiency
Design, build, and maintain business intelligence reporting in collaboration with team leadership
Continually focus on growing technical skills related to reporting tools and coding languages
Partner with leadership and other key business contacts to ensure Medicare data and reporting knowledge is developed and maintained
Support ad-hoc and reoccurring work as needed
QUALIFICATIONS
Highly creative and possess the ability to manage several projects concurrently
Ability to prioritize effectively and to work efficiently
Ability to work both autonomously and together as a team
Highly organized and deadline driven
Professional communication skills, both oral and written to all levels of an organization
KNOWLEDGE, EXPERIENCE, AND EDUCATION
Bachelor's Degree in related field, or equivalent experience
7+ years' experience in pharmacy benefit management, health insurance, or related industry
Experience with Medicare Part D data, including PDE and MMR reporting
Strong understanding of CMS regulations and healthcare analytics
Intermediate to expert in SQL, SAS, R, Python, or other database languages
Intermediate to expert in Power BI, Tableau, Qlik, or similar tool, preferred
COMPETENCIES
Collaborates : Building partnerships and working collaboratively with others to meet shared objectives.
Manages Conflict : Handling conflict situations effectively, with a minimum of noise.
Courage : Stepping up to address difficult issues, saying what needs to be said.
Decision Quality : Making good and timely decisions that keep the organization moving forward.
Values Differences : Recognizing the value that different perspectives and cultures bring to an organization.
Directs Work : Providing direction, delegating, and removing obstacles to get work done.
EEO STATEMENT We champion equality and inclusivity, proudly supporting an Equal Opportunity Employer policy. We welcome applicants regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, age, genetic information, disability, protected veteran status, or any other status protected by law.
Seniority level
Associate
Employment type
Full-time
Job function
Legal
Industries
Staffing and Recruiting
#J-18808-Ljbffr
Considering applying for this job Do not delay, scroll down and make your application as soon as possible to avoid missing out. Join to apply for the
Director, Medicare and Data Compliance
role at
ConsultNet Technology Services and Solutions .
The Director, Medicare and Data Compliance will be responsible for analyzing and interpreting pharmacy data related to Medicare programs, specifically focusing on CMS Direct Subsidy, PDE, and MMR. The role involves working with large datasets, ensuring compliance with CMS regulations, and providing insights to improve healthcare outcomes and financial performance. They will work closely with other team members to collaborate and support team processes. They will be responsible for leading our compliance reporting efforts and partnering with key business stakeholders.
KEY RESPONSIBILITIES
Analyze Medicare data, including PDE submissions, MMR reports, and CMS Direct Subsidy allocations
Work with Finance and Account Management to project yearly Medicare changes
Ensure data accuracy and compliance with CMS guidelines and reporting requirements
Own and maintain reporting processes needed to support organization compliance requirements
Maintain and manage large datasets related to Medicare Part D and other relevant programs
Monitor performance through tracking trends and identifying discrepancies in subsidy allocations and prescription drug events
Work with cross-functional teams, including finance, IT, Account Management, and Compliance to optimize Medicare data usage
Lead process improvement through developing strategies to enhance data collection, reporting, and analysis efficiency
Design, build, and maintain business intelligence reporting in collaboration with team leadership
Continually focus on growing technical skills related to reporting tools and coding languages
Partner with leadership and other key business contacts to ensure Medicare data and reporting knowledge is developed and maintained
Support ad-hoc and reoccurring work as needed
QUALIFICATIONS
Highly creative and possess the ability to manage several projects concurrently
Ability to prioritize effectively and to work efficiently
Ability to work both autonomously and together as a team
Highly organized and deadline driven
Professional communication skills, both oral and written to all levels of an organization
KNOWLEDGE, EXPERIENCE, AND EDUCATION
Bachelor's Degree in related field, or equivalent experience
7+ years' experience in pharmacy benefit management, health insurance, or related industry
Experience with Medicare Part D data, including PDE and MMR reporting
Strong understanding of CMS regulations and healthcare analytics
Intermediate to expert in SQL, SAS, R, Python, or other database languages
Intermediate to expert in Power BI, Tableau, Qlik, or similar tool, preferred
COMPETENCIES
Collaborates : Building partnerships and working collaboratively with others to meet shared objectives.
Manages Conflict : Handling conflict situations effectively, with a minimum of noise.
Courage : Stepping up to address difficult issues, saying what needs to be said.
Decision Quality : Making good and timely decisions that keep the organization moving forward.
Values Differences : Recognizing the value that different perspectives and cultures bring to an organization.
Directs Work : Providing direction, delegating, and removing obstacles to get work done.
EEO STATEMENT We champion equality and inclusivity, proudly supporting an Equal Opportunity Employer policy. We welcome applicants regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, age, genetic information, disability, protected veteran status, or any other status protected by law.
Seniority level
Associate
Employment type
Full-time
Job function
Legal
Industries
Staffing and Recruiting
#J-18808-Ljbffr