Job Summary
- Company
- Prime Therapeutics
- Location
- MINNEAPOLIS, MN 55437
- Industries
- Healthcare Services
- Job Type
- Full Time
- Employee
- Career Level
- Experienced (Non-Manager)
- Job Reference Code
- AA11374
Operational Compliance Coordinator
About the Job
Prime Therapeutics LLC (Prime) is an innovative and emerging leader in the pharmacy benefit management (PBM) industry. Our mission is to provide the highest quality care and service for our members and empower clients to make informed decisions in health care management. Our strategy is to integrate pharmacy and health management for clinical, financial and ultimately member gain. We proudly serve over 14.6 million members across the United States.
If you are looking to make a difference in the lives of others, along with opportunities to develop and advance your career, come join our rapidly growing and dynamic company. We are headquartered in Eagan, Minnesota with major locations in Nebraska, New Mexico and Texas.
Job Summary:
The Operational Compliance Coordinator is responsible for supporting Operational Compliance with the following activities: Monitoring and distributing CMS, Medicaid and any other regulatory guidance, administering quality monitoring program and updating trending spreadsheets/reports, providing assistance with all Medicare, Medicaid, NCQA and commercial audits and standard operating procedures (SOPS), completing and distributing minutes for Centers for Medicare & Medicaid Services (CMS) user group calls, assisting with coordination of Medicare, Medicaid, NCQA, and commercial audits, preparing training calendar and preparing training materials, and maintaining Operational Compliance web site with updated material.
Responsibilities:
•Monitor and distribute CMS Memos and State Medicaid communications to Prime distribution list, maintain Prime distribution list, save the documents to appropriate online site for Prime-wide access, update and distribute related reports to clients weekly.
•Update Quality Monitoring (QM) trending spreadsheets with operational data and work with Operational Compliance Analysts in supporting ongoing development and revisions to the (QM) program.
•Provide support for Medicare, Medicaid, NCQA, and Commercial Standard Operating Procedure (SOP) storage, revisions, work flows and meeting calendar/coordination required for SOP Review Committee (SOPRC).
•Complete and distribute minutes from CMS User Group meetings and save to online site for Prime-wide access.
•Assist in coordination of Medicare, Medicaid, NCQA, and Commercial audits including: Maintenance of audit status grids, submission of required work orders, compilation of materials, creating binders when required, quality review of deliverables, and update related audit corrective action tracking spreadsheets.
•Prepare and coordinate training calendar, prepare presentation materials, and schedule training sessions.
•Maintain Operational Compliance web site with updated materials, including: SOPs, CMS audit support tools, Medicaid related information, and NCQA documentation.
•Other duties as assigned.
Basic Qualifications:
•Bachelor’s degree or 4 years of equivalent work experience
•2-3 years of successful work experience within the healthcare industry or in an administrative support/project coordinator role
Preferred Qualifications:
•Government Programs compliance, audit, and/or Quality Assurance background
•Experience with Medicare Part D and Medicaid
•Experience related to, or within Pharmacy Benefit Management (PBM)
•Project management experience
•Demonstrated excellent written, verbal, and listening communication skills
•Ability to manage multiple, complex projects simultaneously without compromising quality
•Proficiency with Microsoft Office Suite
•Detail oriented
WHY WORK FOR PRIME?
At Prime Therapeutics, we attract the brightest people — those who want to be involved, empowered and rewarded for their achievements. We value people who are ambitious, adaptable to change and dedicated to excellence. We look for candidates who embrace creativity, challenges and collaboration.
Our work facilities are modern, clean and provide our employees with the most up-to-date technology. We have a high-energy, fast-paced culture where we value new ideas, build teamwork, drive results and celebrate our accomplishments.
Prime offers a competitive salary with bonus incentives. In addition, Prime provides an excellent benefit package including: medical, dental, vision, company paid life insurance, company paid disability insurance, generous Paid Time Off, 401(k) with a two component match, tuition reimbursement and more.
We are proud to be an EOE/AA employer. We maintain a drug-free workplace and perform pre-employment substance abuse testing.
Bachelors Degree,Healthcare Experience
If you are looking to make a difference in the lives of others, along with opportunities to develop and advance your career, come join our rapidly growing and dynamic company. We are headquartered in Eagan, Minnesota with major locations in Nebraska, New Mexico and Texas.
Job Summary:
The Operational Compliance Coordinator is responsible for supporting Operational Compliance with the following activities: Monitoring and distributing CMS, Medicaid and any other regulatory guidance, administering quality monitoring program and updating trending spreadsheets/reports, providing assistance with all Medicare, Medicaid, NCQA and commercial audits and standard operating procedures (SOPS), completing and distributing minutes for Centers for Medicare & Medicaid Services (CMS) user group calls, assisting with coordination of Medicare, Medicaid, NCQA, and commercial audits, preparing training calendar and preparing training materials, and maintaining Operational Compliance web site with updated material.
Responsibilities:
•Monitor and distribute CMS Memos and State Medicaid communications to Prime distribution list, maintain Prime distribution list, save the documents to appropriate online site for Prime-wide access, update and distribute related reports to clients weekly.
•Update Quality Monitoring (QM) trending spreadsheets with operational data and work with Operational Compliance Analysts in supporting ongoing development and revisions to the (QM) program.
•Provide support for Medicare, Medicaid, NCQA, and Commercial Standard Operating Procedure (SOP) storage, revisions, work flows and meeting calendar/coordination required for SOP Review Committee (SOPRC).
•Complete and distribute minutes from CMS User Group meetings and save to online site for Prime-wide access.
•Assist in coordination of Medicare, Medicaid, NCQA, and Commercial audits including: Maintenance of audit status grids, submission of required work orders, compilation of materials, creating binders when required, quality review of deliverables, and update related audit corrective action tracking spreadsheets.
•Prepare and coordinate training calendar, prepare presentation materials, and schedule training sessions.
•Maintain Operational Compliance web site with updated materials, including: SOPs, CMS audit support tools, Medicaid related information, and NCQA documentation.
•Other duties as assigned.
Basic Qualifications:
•Bachelor’s degree or 4 years of equivalent work experience
•2-3 years of successful work experience within the healthcare industry or in an administrative support/project coordinator role
Preferred Qualifications:
•Government Programs compliance, audit, and/or Quality Assurance background
•Experience with Medicare Part D and Medicaid
•Experience related to, or within Pharmacy Benefit Management (PBM)
•Project management experience
•Demonstrated excellent written, verbal, and listening communication skills
•Ability to manage multiple, complex projects simultaneously without compromising quality
•Proficiency with Microsoft Office Suite
•Detail oriented
WHY WORK FOR PRIME?
At Prime Therapeutics, we attract the brightest people — those who want to be involved, empowered and rewarded for their achievements. We value people who are ambitious, adaptable to change and dedicated to excellence. We look for candidates who embrace creativity, challenges and collaboration.
Our work facilities are modern, clean and provide our employees with the most up-to-date technology. We have a high-energy, fast-paced culture where we value new ideas, build teamwork, drive results and celebrate our accomplishments.
Prime offers a competitive salary with bonus incentives. In addition, Prime provides an excellent benefit package including: medical, dental, vision, company paid life insurance, company paid disability insurance, generous Paid Time Off, 401(k) with a two component match, tuition reimbursement and more.
We are proud to be an EOE/AA employer. We maintain a drug-free workplace and perform pre-employment substance abuse testing.
Bachelors Degree,Healthcare Experience
Additional Information:
- Travel Percentage: 10%
Company Tools
Contact Information
Prime Therapeutics
