Sr. Financial Analyst, Medicare Part D

 

The Sr. Financial Analyst, Medicare Part D serves as a subject matter expert in Medicare Part D financial operations. This position is responsible for managing financial reconciliations, implementing financial controls, forecasting, reporting, and oversight of CMS and client payments for the Navitus Medicare Part D EGWP product as well as for Navitus Medicare Part D health plan clients. The primary operational responsibilities are focused on Medicare Part D EGWP Finance operations. In addition, operational accountabilities include financial processes that span all Medicare clients including but not limited to Direct and Indirect Remuneration (DIR) support, Medical Loss Ratio (MLR) support, administrative fee support, new Inflation Reduction Act billing & collection support, and CMS Star Ratings support.

 

Is this you? Find out more below!  

How do I make an impact on my team?   

• Develops and maintains deep subject matter expertise related to Medicare Part D Payment processing, Medicare Part D benefit administration, and related financial functions.

• Reconciles monthly, quarterly, and annual (including plan year re-openings) CMS and drug manufacturer reimbursements to the employer group and manages the group level reporting and payments. Manages reporting to CMS as well as dispute processes.

• Administers monthly Plan to Plan (P2P) payment processes, Low Income Premium Subsidy (LIPS) payments, and CMS Late Enrollment Penalty (LEP) billing & collection processes.

• Monitors client performance related to CMS subsidies. Forecasts EGWP client subsidies as required. Collaborates with Navitus Actuarial Services team or external actuarial services partner.

• Oversees cash receipts and distributions and administers CMS overpayment processes.

• Administers Medicare Part D Direct and Indirect Remuneration (DIR) function for all Navitus Part D clients.

• Administers annual Medical Loss Ratio (MLR) function for the Navitus Medicare product and provides MLR reporting support for all Navitus Part D clients.

• Maintains Medicare administrative fees pricing model. Collaborates with General Manager, Medicare Part D and Corporate Underwriting in establishing administrative fees and monitoring performance.

• Administers CMS Star Ratings and Display Measure tracking and reporting capability for all Navitus Part D clients. Participates in the Star Ratings Center of Excellence (COE) team and provides RFP support related to Star Ratings.

• Provides Section 1150A regulatory reporting support for all Part D clients.

• Participate in, adhere to and support compliance and diversity, equity, and inclusion program objectives.

• Other duties as assigned 

What our team expects from you?  

• Bachelor’s degree is required. 

• 5 years of experience in Accounting, Finance, and/or a role with a primary job duty producing financial reports and/or audits is required.

• Medicare health plan or PBM experience is preferred.

• Experience in government programs compliance program participation, adherence, and support is highly desired.

• Project management experience is desired.

• Participate in, adhere to, and support compliance program objectives 

• The ability to consistently interact cooperatively and respectfully with other employees