Analyst, Medicare Audit/Reporting

Role Description

Due to growth, we are adding an Analyst, Medicare Audits/Reporting to our team! The Analyst, Medicare Audits/Reporting will be responsible for a large variety of Medicare Prior Authorization Operations reports that support the Prior Authorization Operations and may be asked to provide additional support during UM audits. The Analyst will be responsible for all PA operations Medicare reporting requests, in-line with the Manager’s goals. Medicare reports include (but are not limited to):

• CMS Coverage Determination (CD) and Coverage Determination Exception Request (CDER) universes
• Part D Plan Reporting for Coverage Determinations and Redeterminations (CDR)
• Independent Review Organization (IRE) client reporting
• NCQA reporting
• Timeliness and Validation Reports

Daily responsibilities include:

• Managing expected timeliness of reports
• Tracking report requests
• Ensuring regulatory requirements of reports are met
• Providing oversight on PA coordinator reports
• Providing quality oversight and support on all Medicare D operations reports
• Creating new reports
• Identifying and reporting any gaps in reporting capabilities
• Ensuring accuracy in delivered reports

Qualifications

• Associate degree in business or mathematics preferred or equivalent experience
• 2 years of applicable Medicare Prior Authorization processing experience, or 2 years of Medicare reporting experience is required
• Participate in, adhere to, and support compliance program objectives
• The ability to consistently interact cooperatively and respectfully with other employees

Requirements

• Work with the Manager to execute goals and objectives for Prior Authorization Operations Medicare reporting needs
• Execute on reporting requests, audit deliverables, monthly/quarterly Medicare reports, Ad Hoc report requests from clients and/or other internal departments, and support Manager in testing new reporting enhancements
• Execute on project work associated with Navitus’ Prior Authorization Operations Medicare reporting from inception through completion
• Troubleshoot for reporting issues or questions
• Ensure controls are in place that adequately ensure quality in Prior Authorization Medicare report deliverables
• Work with end users to suggest enhancements to the system or workflow processes to meet the needs of the business
• Identify enhancement requirements for new processes, services and changes to existing processes and services to achieve department business and strategic goals
• Other duties as assigned

Benefits

• Top of the industry benefits for Health, Dental, and Vision insurance
• 20 days paid time off
• 4 weeks paid parental leave
• 9 paid holidays
• 401K company match of up to 5% - No vesting requirement
• Adoption Assistance Program
• Flexible Spending Account
• Educational Assistance Plan and Professional Membership assistance
• Referral Bonus Program – up to $750!